Provider Demographics
NPI:1144223280
Name:GAJJAR, AMAR J (MD)
Entity Type:Individual
Prefix:DR
First Name:AMAR
Middle Name:J
Last Name:GAJJAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 DANNY THOMAS PL
Mailing Address - Street 2:MS 515
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38105-3678
Mailing Address - Country:US
Mailing Address - Phone:901-595-3006
Mailing Address - Fax:901-595-3842
Practice Address - Street 1:262 DANNY THOMAS PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38105-3678
Practice Address - Country:US
Practice Address - Phone:901-595-3006
Practice Address - Fax:901-595-3842
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN196782080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009914300Medicaid
NE100249681-00Medicaid
MI104689590Medicaid
GA672249326AMedicaid
TN3088948Medicaid
NJ0030538Medicaid
IA0530063Medicaid
AR126572001Medicaid
LA1653411Medicaid
KS10067820AMedicaid
MO207838111Medicaid
NM82736863Medicaid
MS00114605Medicaid
ME422400000Medicaid
IL441846883-2Medicaid
KY64921109Medicaid
IN200181340AMedicaid
OH2004468Medicaid
MI104689590Medicaid
MO207838111Medicaid