Provider Demographics
NPI:1174904684
Name:JUBE-DESAI, NEENA (MD)
Entity type:Individual
Prefix:
First Name:NEENA
Middle Name:
Last Name:JUBE-DESAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NEENA
Other - Middle Name:
Other - Last Name:JUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 62063
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2063
Mailing Address - Country:US
Mailing Address - Phone:410-706-5181
Mailing Address - Fax:410-706-5103
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-6749
Practice Address - Fax:410-328-7305
Is Sole Proprietor?:No
Enumeration Date:2015-06-11
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD046174208000000X
MDD91609208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics