Provider Demographics
NPI:1619021003
Name:DESAI, JAYANT B (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYANT
Middle Name:B
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:716 MAIDEN CHOICE LN
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5943
Mailing Address - Country:US
Mailing Address - Phone:410-788-8264
Mailing Address - Fax:410-788-8254
Practice Address - Street 1:716 MAIDEN CHOICE LN
Practice Address - Street 2:SUITE 302
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21228-5943
Practice Address - Country:US
Practice Address - Phone:410-788-8264
Practice Address - Fax:410-788-8254
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2008-04-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0022417208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
T5260001OtherCARE FIRST
MD020001226OtherRR MC #
MD130551400Medicaid
MD41272703OtherCARE FIRST
MD2758Medicare PIN
D72049Medicare UPIN