Healthcare Provider Details

I. General information

NPI: 1104126325
Provider Name (Legal Business Name): AJIT M CHIKARMANE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 11/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 N LAUREL ST 2B
HAZLETON PA
18201-5948
US

IV. Provider business mailing address

20 N LAUREL ST 2B
HAZLETON PA
18201-5948
US

V. Phone/Fax

Practice location:
  • Phone: 570-454-5715
  • Fax: 570-455-5095
Mailing address:
  • Phone: 570-454-5715
  • Fax: 570-455-5095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD027889E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0017877850002
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: AJIT M CHIKARMANE
Title or Position: PRESIDENT
Credential: MD
Phone: 570-454-5715