Provider Demographics
NPI:1215024195
Name:KWATRA, AJAY (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:KWATRA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:235 ANGEL LEAF RD
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-2755
Mailing Address - Country:US
Mailing Address - Phone:855-259-2872
Mailing Address - Fax:888-815-6161
Practice Address - Street 1:690 S LOOP 336 W
Practice Address - Street 2:SUITE 200
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-3319
Practice Address - Country:US
Practice Address - Phone:936-441-1005
Practice Address - Fax:936-521-1138
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ6530208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103746702Medicaid
GA340016238Medicare PIN
TX103746702Medicaid
TX83877JMedicare PIN