Provider Demographics
NPI:1942286620
Name:NANDA, AJIT S (MD)
Entity Type:Individual
Prefix:DR
First Name:AJIT
Middle Name:S
Last Name:NANDA
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 1:11373 S PRESTON HWY
Mailing Address - Street 2:P.O. BOX 399
Mailing Address - City:LEBANON JUNCTION
Mailing Address - State:KY
Mailing Address - Zip Code:40150-8472
Mailing Address - Country:US
Mailing Address - Phone:502-833-2619
Mailing Address - Fax:502-833-3655
Practice Address - Street 1:11373 S PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LEBANON JUNCTION
Practice Address - State:KY
Practice Address - Zip Code:40150-8472
Practice Address - Country:US
Practice Address - Phone:502-833-2619
Practice Address - Fax:502-833-3655
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2010-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY35320207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine