Basic Information
Provider Information | |||||||||
NPI: | 1316058498 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | MIDATLANTIC UROLOGY ASSOCIATES LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 7500 GREENWAY CENTER DR | ||||||||
Address2: | 8TH FLOOR | ||||||||
City: | GREENBELT | ||||||||
State: | MD | ||||||||
PostalCode: | 207703502 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3014772000 | ||||||||
FaxNumber: | 3014772981 | ||||||||
Practice Location | |||||||||
Address1: | 7500 GREENWAY CENTER DR | ||||||||
Address2: | 8TH FLOOR | ||||||||
City: | GREENBELT | ||||||||
State: | MD | ||||||||
PostalCode: | 207703502 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3014772000 | ||||||||
FaxNumber: | 3014772981 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/31/2006 | ||||||||
LastUpdateDate: | 11/28/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | AJRAWAT | ||||||||
AuthorizedOfficialFirstName: | HARBHAJAN | ||||||||
AuthorizedOfficialMiddleName: | S | ||||||||
AuthorizedOfficialTitleorPosition: | CHAIRMAN | ||||||||
AuthorizedOfficialTelephone: | 3014772000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | M.D. | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |   |
ID Information
ID | Type | State | Issuer | Description | DG5243 | 01 |   | RAILROAD MEDICARE | OTHER |