Provider Demographics
NPI:1881660900
Name:GUNDROO, AIJAZ A (MD)
Entity Type:Individual
Prefix:
First Name:AIJAZ
Middle Name:A
Last Name:GUNDROO
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 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-4837
Mailing Address - Fax:
Practice Address - Street 1:543 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43203-1278
Practice Address - Country:US
Practice Address - Phone:614-293-4837
Practice Address - Fax:614-293-3125
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002535207RN0300X
OH35.135012207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2513134OtherINDEPENDENT HEALTH
NY000528379001OtherHEALTH NOW
NY02741500Medicaid
NY00027482501OtherEXCELLUS UNIVERIA
NYI50281Medicare UPIN
NY02741500Medicaid