Provider Demographics
NPI:1861051419
Name:DESAI, DEV (MD)
Entity type:Individual
Prefix:
First Name:DEV
Middle Name:
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 1:120 E OLENTANGY ST
Mailing Address - Street 2:
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-9069
Mailing Address - Country:US
Mailing Address - Phone:614-898-1211
Mailing Address - Fax:614-961-1096
Practice Address - Street 1:120 E OLENTANGY ST
Practice Address - Street 2:
Practice Address - City:POWELL
Practice Address - State:OH
Practice Address - Zip Code:43065-9069
Practice Address - Country:US
Practice Address - Phone:614-898-1211
Practice Address - Fax:614-961-1096
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.144297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine