Provider Demographics
NPI:1881730067
Name:DESAI, KARTIK J (MD)
Entity type:Individual
Prefix:
First Name:KARTIK
Middle Name:J
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KARTIK
Other - Middle Name:J
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3290 N RIDGE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-3655
Mailing Address - Country:US
Mailing Address - Phone:410-313-9292
Mailing Address - Fax:410-313-9293
Practice Address - Street 1:3290 N RIDGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-3655
Practice Address - Country:US
Practice Address - Phone:410-313-9292
Practice Address - Fax:410-313-9293
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0062704174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4082737 00Medicaid
MD4082737 00Medicaid
MD130573ZAH1Medicare PIN