Healthcare Provider Details

I. General information

NPI: 1134548894
Provider Name (Legal Business Name): KUNAL AJMERA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2014
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8813 WALTHAM WOODS RD STE 204
PARKVILLE MD
21234-2577
US

IV. Provider business mailing address

8813 WALTHAM WOODS RD STE 204
PARKVILLE MD
21234-2577
US

V. Phone/Fax

Practice location:
  • Phone: 410-661-4670
  • Fax:
Mailing address:
  • Phone: 312-806-0353
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD82404
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: