Provider Demographics
NPI:1336866474
Name:RAVI DESAI MD LLC
Entity Type:Organization
Organization Name:RAVI DESAI MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:DESAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-491-7164
Mailing Address - Street 1:2540 EARLY SPRING CT
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-6656
Mailing Address - Country:US
Mailing Address - Phone:732-491-7164
Mailing Address - Fax:937-350-6477
Practice Address - Street 1:2540 EARLY SPRING CT
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-6656
Practice Address - Country:US
Practice Address - Phone:732-491-7164
Practice Address - Fax:937-350-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-19
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0162690Medicaid