Provider Demographics
NPI:1376634626
Name:DESAI, RUPAL R (MD)
Entity Type:Individual
Prefix:DR
First Name:RUPAL
Middle Name:R
Last Name:DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 DORSEY HALL DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7766
Mailing Address - Country:US
Mailing Address - Phone:410-997-5191
Mailing Address - Fax:410-997-7957
Practice Address - Street 1:4801 DORSEY HALL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7766
Practice Address - Country:US
Practice Address - Phone:410-997-5191
Practice Address - Fax:410-997-7957
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0061688207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD137304ZJKVMedicare PIN
MDI25207Medicare UPIN