Provider Demographics
NPI:1073801130
Name:JADA, AJIT SIVANANDA (MD)
Entity Type:Individual
Prefix:DR
First Name:AJIT
Middle Name:SIVANANDA
Last Name:JADA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:255 W LANCASTER AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:PAOLI
Mailing Address - State:PA
Mailing Address - Zip Code:19301-1763
Mailing Address - Country:US
Mailing Address - Phone:610-325-3880
Mailing Address - Fax:610-325-3887
Practice Address - Street 1:255 W LANCASTER AVE STE 201
Practice Address - Street 2:
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301
Practice Address - Country:US
Practice Address - Phone:610-325-3880
Practice Address - Fax:610-325-3887
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD464773207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery