Provider Demographics
NPI:1417956905
Name:PONKSHE, AJAY (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:PONKSHE
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 1:3333 BURNET AVE ML 7009
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-4830
Mailing Address - Fax:513-636-7868
Practice Address - Street 1:3333 BURNET AVE
Practice Address - Street 2:ML 7009
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4830
Practice Address - Fax:513-636-7868
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2015-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.085690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64089949Medicaid
KYKTP63401OtherCHOICE CARE
KY000000351040OtherANTHEM
KY0398424Medicare ID - Type Unspecified
KY64089949Medicaid