MEDICARE: DR. AJANTA DE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	C55862	CA
2	207RC0000X	Cardiovascular Disease Physician	C55862	CA
3	207RI0011X	Interventional Cardiology Physician	C55862	CA

General Provider Information

NPI Number	:	1336198878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AJANTA DE M.D.

Provider Business Mailing Address
First Line	:	1850 EL CAMINO REAL STE 200
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3102
Country	:	US
Telephone Number	:	650-697-2431
Fax Number	:	650-697-3659

Provider Business Practice Location Address
First Line	:	1850 EL CAMINO REAL STE 200
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3102
Country	:	US
Telephone Number	:	650-697-2431
Fax Number	:	650-697-3659

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	03/07/2023

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Directions to “ DR. AJANTA DE M.D.” Practice Location

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