Provider Demographics
NPI:1235125170
Name:RAMACHANDRAN, AJITH (MD)
Entity Type:Individual
Prefix:
First Name:AJITH
Middle Name:
Last Name:RAMACHANDRAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 WESTOVER TER
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7128
Mailing Address - Country:US
Mailing Address - Phone:336-373-0611
Mailing Address - Fax:336-373-1589
Practice Address - Street 1:1511 WESTOVER TER
Practice Address - Street 2:SUITE 201
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7128
Practice Address - Country:US
Practice Address - Phone:336-373-0611
Practice Address - Fax:336-373-1589
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200300083207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG78486Medicare UPIN
NC2013156Medicare ID - Type Unspecified