Provider Demographics
NPI:1487677886
Name:WAGHRAY, AMIT (MD)
Entity Type:Individual
Prefix:
First Name:AMIT
Middle Name:
Last Name:WAGHRAY
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 7540
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85246-7540
Mailing Address - Country:US
Mailing Address - Phone:480-926-0170
Mailing Address - Fax:480-452-0715
Practice Address - Street 1:3115 S PRICE RD
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248-3544
Practice Address - Country:US
Practice Address - Phone:888-488-7640
Practice Address - Fax:480-452-0715
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34299207R00000X
FLME108755207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ951005Medicaid
AZZ165695Medicare PIN
AZ951005Medicaid