=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780719179
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMIT PRAKASH DESAI MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/23/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1830 E MONUMENT ST SUITE 6-100
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21287-0020
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-955-5107
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9 LINCOLN WOODS WAY APT 2D
-----------------------------------------------------
City | PERRY HALL
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21128-9346
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 215-694-8693
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number | P21353
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------