Provider Demographics
NPI:1619012978
Name:AJIT P. KURUVILLA M.D., LLC
Entity Type:Organization
Organization Name:AJIT P. KURUVILLA M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:AJIT
Authorized Official - Middle Name:P
Authorized Official - Last Name:KURUVILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-570-9700
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-0157
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:301-570-9700
Practice Address - Fax:301-260-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0046187207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Not Answered207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568487247OtherNPI NUMBER
001880S72Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
1568487247OtherNPI NUMBER