Provider Demographics
NPI:1760145486
Name:KHATIWADA, AJAY
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:KHATIWADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8746 LINICK DR
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-4782
Mailing Address - Country:US
Mailing Address - Phone:602-814-9299
Mailing Address - Fax:
Practice Address - Street 1:8746 LINICK DR
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-4782
Practice Address - Country:US
Practice Address - Phone:602-814-9299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker