1871553529 NPI number — MR. AJAY NEILCHAND YEDDU I MD

Table of content: MR. AJAY NEILCHAND YEDDU I MD (NPI 1871553529)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871553529 NPI number — MR. AJAY NEILCHAND YEDDU I MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YEDDU
Provider First Name:
AJAY
Provider Middle Name:
NEILCHAND
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
I
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
YEDDU
Provider Other First Name:
AJAY
Provider Other Middle Name:
NEILCHAND
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871553529
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HIGLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85236-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-838-1914
Provider Business Mailing Address Fax Number:
480-838-9434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1410 W GUADALUPE RD
Provider Second Line Business Practice Location Address:
BUILDING 4 SUITE 125
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85233-3003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-838-1914
Provider Business Practice Location Address Fax Number:
480-838-9434
Provider Enumeration Date:
03/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  34866 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: MD-15499R , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 34866 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1423360 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34866 . This is a "AZ STATE LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 081425 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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