Provider Demographics
NPI:1467663856
Name:NARAYAN, AJITA (MD, PHD)
Entity Type:Individual
Prefix:
First Name:AJITA
Middle Name:
Last Name:NARAYAN
Suffix:
Gender:F
Credentials:MD, PHD
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 781076
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1076
Mailing Address - Country:US
Mailing Address - Phone:317-528-4800
Mailing Address - Fax:317-865-1479
Practice Address - Street 1:1701 S CREASY LN STE 1W93
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-4972
Practice Address - Country:US
Practice Address - Phone:765-502-4015
Practice Address - Fax:765-471-5461
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57012171207RH0003X
IN01066485A207RH0003X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000720778OtherANTHEM PROVIDER NUMBER
IN200952850Medicaid
IN200952850Medicaid
IN000000720778OtherANTHEM PROVIDER NUMBER
IN815150CCCCMedicare PIN
IN815150010Medicare PIN