Provider Demographics
NPI:1063570299
Name:DESAI, AMEE B (MD)
Entity type:Individual
Prefix:
First Name:AMEE
Middle Name:B
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:P.O. BOX 64916
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4916
Mailing Address - Country:US
Mailing Address - Phone:443-481-6482
Mailing Address - Fax:443-481-6515
Practice Address - Street 1:2001 MEDICAL PARKWAY
Practice Address - Street 2:ACUTE CARE PAVILLION
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3280
Practice Address - Country:US
Practice Address - Phone:443-481-1000
Practice Address - Fax:443-481-1687
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2011-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08183700207R00000X
MDD0070970207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
607156012OtherFEDERAL WORKMAN'S COMP (DEPT OF LABOR)
97128101OtherCAREFIRST
V8260028OtherCAREFIRST
MD520096200Medicaid
607156012OtherDEPT OF LABOR
607156012OtherDEPT OF LABOR
V8260028OtherCAREFIRST
NJI72190Medicare UPIN