Provider Demographics
NPI:1053319293
Name:TIWARI, AJIT D (OD)
Entity Type:Individual
Prefix:DR
First Name:AJIT
Middle Name:D
Last Name:TIWARI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S SYCAMORE ST
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23803-5041
Mailing Address - Country:US
Mailing Address - Phone:804-732-5481
Mailing Address - Fax:804-732-8675
Practice Address - Street 1:300 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23803-5041
Practice Address - Country:US
Practice Address - Phone:804-732-5481
Practice Address - Fax:804-732-8675
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-12
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000571152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA3977120002OtherADMINISTAR
VADN3306OtherMEDICARE RAILROAD
VA009233245Medicaid
VA410040945OtherMEDICARE RAILROAD
VA410040945OtherMEDICARE RAILROAD
VADN3306OtherMEDICARE RAILROAD
VA009233245Medicaid