Provider Demographics
NPI:1417900051
Name:KURUP, AJIT G (MD)
Entity Type:Individual
Prefix:DR
First Name:AJIT
Middle Name:G
Last Name:KURUP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1835 UNIVERSITY BLVD E STE 208
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-4657
Mailing Address - Country:US
Mailing Address - Phone:301-445-3501
Mailing Address - Fax:301-445-3502
Practice Address - Street 1:1835 UNIVERSITY BLVD E STE 208
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-4657
Practice Address - Country:US
Practice Address - Phone:301-445-3501
Practice Address - Fax:301-445-3502
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063681207QG0300X
MDD63681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410835300Medicaid
DCG02643V01Medicare PIN
MD410835300Medicaid
MDG02643V01Medicare PIN
I36608Medicare UPIN