Healthcare Provider Details

I. General information

NPI: 1962426817
Provider Name (Legal Business Name): AJAY KUMAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E WENDOVER AVE STE 211
GREENSBORO NC
27401-1232
US

IV. Provider business mailing address

PO BOX 14883
GREENSBORO NC
27415-4883
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-3088
  • Fax: 336-832-3080
Mailing address:
  • Phone: 336-378-1076
  • Fax: 336-378-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number29935
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: