Basic Information
| Provider Information | |||||||||
| NPI: | 1669411476 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DAS | ||||||||
| FirstName: | AJIT | ||||||||
| MiddleName: | KUMAR | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62063 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212642063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4107065181 | ||||||||
| FaxNumber: | 4107065103 | ||||||||
| Practice Location | |||||||||
| Address1: | 827 LINDEN AVE FL 1 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212014606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102258780 | ||||||||
| FaxNumber: | 4102258766 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | D0032132 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | AD3108176 | 01 | MD | DEA # | OTHER | 375031100 | 05 | MD | MEDICAID | S2560010 | 01 | DC | DC BLUE CROSS # | OTHER | 399690-04 | 01 | MD | CAREFIRST BCBS # | OTHER |