Provider Demographics
NPI:1659387447
Name:DWIVEDI, AJIT (DO)
Entity Type:Individual
Prefix:
First Name:AJIT
Middle Name:
Last Name:DWIVEDI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8901 BOONE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77099-1659
Mailing Address - Country:US
Mailing Address - Phone:281-454-0500
Mailing Address - Fax:
Practice Address - Street 1:2727 W HOLCOMBE BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-1669
Practice Address - Country:US
Practice Address - Phone:713-442-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2310207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280140901Medicaid
TX280410903Medicaid
TX280140908Medicaid
TX280410903Medicaid
TX8J2012Medicare PIN
TX8J2014Medicare PIN
TXTXB125350Medicare PIN
TXTXB125348Medicare PIN
TX280140908Medicaid
TX280140901Medicaid