Provider Demographics
NPI:1952445322
Name:DESAI, NIDHI JAYANT (MD)
Entity Type:Individual
Prefix:
First Name:NIDHI
Middle Name:JAYANT
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 1:534 RHAPSODY CT
Mailing Address - Street 2:
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1915
Mailing Address - Country:US
Mailing Address - Phone:917-622-5440
Mailing Address - Fax:
Practice Address - Street 1:534 RHAPSODY CT
Practice Address - Street 2:
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-1915
Practice Address - Country:US
Practice Address - Phone:917-622-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-17
Last Update Date:2011-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436077207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD950994OtherCAREFIRST MD BCBS
PA2090216OtherHIGHMARK BLUE SHIELD
PA102257418Medicaid
PA145047FLTMedicare PIN