Provider Demographics
NPI:1023372679
Name:RATHORE, AJAY S (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:S
Last Name:RATHORE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:856 J CLYDE MORRIS BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23601-1318
Mailing Address - Country:US
Mailing Address - Phone:757-316-5800
Mailing Address - Fax:757-534-5190
Practice Address - Street 1:739 THIMBLE SHOALS BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-3562
Practice Address - Country:US
Practice Address - Phone:757-873-1009
Practice Address - Fax:757-873-7689
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2017-12-08
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Provider Licenses
StateLicense IDTaxonomies
VA0101261994207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology