Healthcare Provider Details

I. General information

NPI: 1033573407
Provider Name (Legal Business Name): ASHWIN JAIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2016
Last Update Date: 08/25/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 E MOREHEAD ST STE 300
CHARLOTTE NC
28202-2742
US

IV. Provider business mailing address

4015 CRAFT ST
CHARLOTTE NC
28217-1651
US

V. Phone/Fax

Practice location:
  • Phone: 704-334-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberT288342
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number271414
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2022-01541
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: