Provider Demographics
NPI:1639401615
Name:BHARDWAJ, AJAY KUMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:AJAY
Middle Name:KUMAR
Last Name:BHARDWAJ
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 1:1100 BOARDMAN CANFIELD RD
Mailing Address - Street 2:APT 57B
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-8056
Mailing Address - Country:US
Mailing Address - Phone:330-397-5741
Mailing Address - Fax:
Practice Address - Street 1:1053 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1007
Practice Address - Country:US
Practice Address - Phone:330-480-3605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57.015431207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine