Provider Demographics
NPI:1568487247
Name:KURUVILLA, AJIT PHILIP (MD)
Entity Type:Individual
Prefix:
First Name:AJIT
Middle Name:PHILIP
Last Name:KURUVILLA
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 299
Mailing Address - Street 2:
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866-0299
Mailing Address - Country:US
Mailing Address - Phone:301-570-9700
Mailing Address - Fax:301-260-2838
Practice Address - Street 1:11125 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 208
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3142
Practice Address - Country:US
Practice Address - Phone:301-881-5858
Practice Address - Fax:301-260-2838
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD46187207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCB602OtherBCBS PROVIDER NUMBER
MD174500000Medicaid
MD175502100Medicaid
DCB602OtherBCBS PROVIDER NUMBER
G22257Medicare UPIN
MD175502100Medicaid