Provider Demographics
NPI:1417161704
Name:BHATNAGAR, AJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:
Last Name:BHATNAGAR
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:PO BOX 15088
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85060-5088
Mailing Address - Country:US
Mailing Address - Phone:480-360-4009
Mailing Address - Fax:480-360-4124
Practice Address - Street 1:1445 W CHANDLER BLVD STE A5
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-6130
Practice Address - Country:US
Practice Address - Phone:480-360-4009
Practice Address - Fax:480-360-4124
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2023-14952085R0001X
PA4251122085R0001X
CA1105612085R0001X
NV232762085R0001X
COCDR.00023792085R0001X
AZ363902085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ264354Medicaid
AZ7802920OtherAETNA
FLP01505470OtherRAILROAD MEDICARE
AZ7055777OtherCIGNA
AZ7802920OtherAETNA
AZ264354Medicare PIN
AZ11725ZMedicare PIN