1508157736 NPI number — AJAY DHAROD M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508157736 NPI number — AJAY DHAROD M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

DHAROD

Provider First Name:

AJAY

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1508157736

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

03/13/2025

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

MEDICAL CENTER BLVD

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

WINSTON SALEM

Provider Business Mailing Address State Name:

NC

Provider Business Mailing Address Postal Code:

27157-0001

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

336-716-3182

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

MEDICAL CENTER BLVD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

WINSTON SALEM

Provider Business Practice Location Address State Name:

NC

Provider Business Practice Location Address Postal Code:

27157-0001

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

336-716-3182

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

04/21/2011

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  DR.0070983 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208M00000X , with the licence number: DR.0070983 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207R00000X , with the licence number: 2014-00629 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 1508157736 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 1508157736 . This is a "VIRGINIA MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 5069158 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 280971 . This is a "MEDCOST" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 5505926 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: P01360486 . This is a "RR MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: Q29014 . This is a "SC MEDICAID" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1861H . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
• Identifier: 1508157736 . This is a "TRICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".