Provider Demographics
NPI:1952307258
Name:DESAI, UJWALA VIVEK (MD)
Entity Type:Individual
Prefix:DR
First Name:UJWALA
Middle Name:VIVEK
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 1:9501 OLD ANNAPOLIS ROAD
Mailing Address - Street 2:SUITE 308
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042
Mailing Address - Country:US
Mailing Address - Phone:301-621-6570
Mailing Address - Fax:301-621-6589
Practice Address - Street 1:9501 OLD ANNAPOLIS ROAD
Practice Address - Street 2:SUITE 308
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042
Practice Address - Country:US
Practice Address - Phone:301-621-6570
Practice Address - Fax:301-621-6589
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD48105207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MHG31803Medicare UPIN
MDS732-929RMedicare ID - Type Unspecified
MDA38105Medicare UPIN