1619012978 NPI number — AJIT P. KURUVILLA M.D., LLC

Table of content: (NPI 1619012978)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619012978 NPI number — AJIT P. KURUVILLA M.D., LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AJIT P. KURUVILLA M.D., LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619012978
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 157
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20861-0157
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-570-9700
Provider Business Mailing Address Fax Number:
301-260-2838

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11125 ROCKVILLE PIKE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-3142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-570-9700
Provider Business Practice Location Address Fax Number:
301-260-2838
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KURUVILLA
Authorized Official First Name:
AJIT
Authorized Official Middle Name:
P
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
301-570-9700

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  D0046187 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207RP1001X , with the licence number: D0046187 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1568487247 . This is a "NPI NUMBER" identifier . This identifiers is of the category "OTHER".




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