Provider Demographics
NPI:1447465232
Name:DESAI, ANISH SUMANT (MD)
Entity type:Individual
Prefix:
First Name:ANISH
Middle Name:SUMANT
Last Name:DESAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7115 GUILFORD DR
Mailing Address - Street 2:#202
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-5199
Mailing Address - Country:US
Mailing Address - Phone:301-663-5922
Mailing Address - Fax:301-663-8292
Practice Address - Street 1:7115 GUILFORD DR
Practice Address - Street 2:SUITE #202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5236
Practice Address - Country:US
Practice Address - Phone:301-663-5922
Practice Address - Fax:301-663-8292
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236647207R00000X, 207RP1001X
MDD0067657207RC0200X, 207RP1001X
DCMD035711207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD416381800Medicaid
MD416381800Medicaid