MEDICARE: AJAY KWATRA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	J6530	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215024195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AJAY KWATRA MD

Provider Business Mailing Address
First Line	:	235 ANGEL LEAF RD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77380-2755
Country	:	US
Telephone Number	:	855-259-2872
Fax Number	:	888-815-6161

Provider Business Practice Location Address
First Line	:	690 S LOOP 336 W
Second Line	:	SUITE 200
City	:	CONROE
State	:	TX
Zip	:	77304-3319
Country	:	US
Telephone Number	:	936-441-1005
Fax Number	:	936-521-1138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/13/2016

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Directions to “ AJAY KWATRA MD” Practice Location

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