Healthcare Provider Details

I. General information

NPI: 1598778805
Provider Name (Legal Business Name): CHALLA AJIT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: AJIT CHALLA MD

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2355 DERR RD
SPRINGFIELD OH
45503-2433
US

IV. Provider business mailing address

2355 DERR RD
SPRINGFIELD OH
45503-2433
US

V. Phone/Fax

Practice location:
  • Phone: 937-629-0100
  • Fax: 937-629-3285
Mailing address:
  • Phone: 937-629-0100
  • Fax: 937-629-3285

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number35.082392
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: