Provider Demographics
NPI:1609974310
Name:DAMANIA, ASHWIN B (MD)
Entity Type:Individual
Prefix:
First Name:ASHWIN
Middle Name:B
Last Name:DAMANIA
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 1:511 THORNHILL DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60188
Mailing Address - Country:US
Mailing Address - Phone:630-668-6620
Mailing Address - Fax:630-668-3120
Practice Address - Street 1:511 THORNHILL DRIVE
Practice Address - Street 2:SUITE D
Practice Address - City:CAROL STREAM
Practice Address - State:IL
Practice Address - Zip Code:60188
Practice Address - Country:US
Practice Address - Phone:630-668-6620
Practice Address - Fax:630-668-3120
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL36052667207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
663870Medicare ID - Type Unspecified
D14539Medicare UPIN