Healthcare Provider Details

I. General information

NPI: 1447067418
Provider Name (Legal Business Name): AJIT P. KURUVILLA M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2024
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 HURLEY AVE
ROCKVILLE MD
20850-3118
US

IV. Provider business mailing address

8129 HUNTFIELD DR
FULTON MD
20759-2104
US

V. Phone/Fax

Practice location:
  • Phone: 301-762-8900
  • Fax:
Mailing address:
  • Phone: 301-758-9697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AJIT PHILIP KURUVILLA
Title or Position: PARTNER
Credential: MD
Phone: 301-758-9697