Provider Demographics
NPI:1326059015
Name:DASHOTTAR, AJAY (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:DASHOTTAR
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 1:7207 HANOVER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2015
Mailing Address - Country:US
Mailing Address - Phone:301-220-0096
Mailing Address - Fax:301-982-9388
Practice Address - Street 1:7207 HANOVER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2015
Practice Address - Country:US
Practice Address - Phone:301-220-0096
Practice Address - Fax:301-982-9388
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025977207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
409450Medicare ID - Type Unspecified
DC9623OtherBCBS
MDB94626Medicare UPIN