Healthcare Provider Details

I. General information

NPI: 1518172279
Provider Name (Legal Business Name): AJIT HALDIPUR JANARDHAN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

860 CENTURY MEDICAL DR
TITUSVILLE FL
32796-2141
US

IV. Provider business mailing address

860 CENTURY MEDICAL DR
TITUSVILLE FL
32796-2141
US

V. Phone/Fax

Practice location:
  • Phone: 321-268-6111
  • Fax: 386-263-2996
Mailing address:
  • Phone: 321-265-4629
  • Fax: 850-682-6302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME122917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: