Provider Demographics
NPI:1548595127
Name:DHARIA, AJAY SUSHEEL (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:SUSHEEL
Last Name:DHARIA
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 1:1750 EL CAMINO REAL STE 307
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3216
Mailing Address - Country:US
Mailing Address - Phone:858-243-8481
Mailing Address - Fax:
Practice Address - Street 1:1750 EL CAMINO REAL STE 307
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3216
Practice Address - Country:US
Practice Address - Phone:858-243-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-15
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA114612207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease