Provider Demographics
NPI:1265469316
Name:JAIN, ASHOKKUMAR BABULAL (MBBS, FACS)
Entity Type:Individual
Prefix:DR
First Name:ASHOKKUMAR
Middle Name:BABULAL
Last Name:JAIN
Suffix:
Gender:M
Credentials:MBBS, FACS
Other - Prefix:
Other - First Name:ASHOK
Other - Middle Name:KUMAR
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MBBS, FACS
Mailing Address - Street 1:PO BOX 858
Mailing Address - Street 2:CA410
Mailing Address - City:HERSHEY
Mailing Address - State:PA
Mailing Address - Zip Code:17033-0858
Mailing Address - Country:US
Mailing Address - Phone:800-243-1455
Mailing Address - Fax:
Practice Address - Street 1:500 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:HERSHEY
Practice Address - State:PA
Practice Address - Zip Code:17033-2360
Practice Address - Country:US
Practice Address - Phone:800-243-1455
Practice Address - Fax:717-531-5851
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046014L204F00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014242050007Medicaid
NY01537411Medicaid
NYDD4527Medicare PIN