Provider Demographics
NPI:1972584225
Name:DESAI, SWATI MANOJ
Entity type:Individual
Prefix:DR
First Name:SWATI
Middle Name:MANOJ
Last Name:DESAI
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SWATI
Other - Middle Name:DINESH
Other - Last Name:DESAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2480 LLEWELLYN AVE
Mailing Address - Street 2:KIMBROUGH AMBULATORY CARE CENTER
Mailing Address - City:FT MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-5800
Mailing Address - Country:US
Mailing Address - Phone:301-677-8897
Mailing Address - Fax:301-677-8299
Practice Address - Street 1:2480 LLEWELLYN AVE
Practice Address - Street 2:KIMBROUGH AMBULATORY CARE CENTER
Practice Address - City:FT MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-5800
Practice Address - Country:US
Practice Address - Phone:301-677-8897
Practice Address - Fax:301-677-8820
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43417207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine