Provider Demographics
NPI:1598778805
Name:AJIT, CHALLA (MD)
Entity Type:Individual
Prefix:DR
First Name:CHALLA
Middle Name:
Last Name:AJIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:AJIT
Other - Middle Name:
Other - Last Name:CHALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2355 DERR RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503-2433
Mailing Address - Country:US
Mailing Address - Phone:937-629-0100
Mailing Address - Fax:937-629-3285
Practice Address - Street 1:2355 DERR RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503-2433
Practice Address - Country:US
Practice Address - Phone:937-629-0100
Practice Address - Fax:937-629-3285
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.082392207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH80400OtherUPIN
OH2388269Medicaid
OH4102902Medicare PIN