1801131024 NPI number — AJIT P KURUVILLA MD LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801131024 NPI number — AJIT P KURUVILLA MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AJIT P KURUVILLA MD 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:
1801131024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/06/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8129 HUNTFIELD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FULTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20759-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-758-9697
Provider Business Mailing Address Fax Number:
301-668-5233

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 RESEARCH BLVD
Provider Second Line Business Practice Location Address:
SUITE 350
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-758-9697
Provider Business Practice Location Address Fax Number:
301-668-5233
Provider Enumeration Date:
11/28/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KURUVILLA
Authorized Official First Name:
AJIT
Authorized Official Middle Name:
P
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
301-758-9697

Provider Taxonomy Codes

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

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

  • Identifier: 214050100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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