Provider Demographics
NPI:1972708527
Name:JADHAV, ASHUTOSH P (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ASHUTOSH
Middle Name:P
Last Name:JADHAV
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7242 E OSBORN RD # 420
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251
Mailing Address - Country:US
Mailing Address - Phone:480-425-8004
Mailing Address - Fax:602-294-8298
Practice Address - Street 1:7242 E. OSBORN RD # 420
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251
Practice Address - Country:US
Practice Address - Phone:480-425-8004
Practice Address - Fax:602-294-8298
Is Sole Proprietor?:No
Enumeration Date:2007-06-15
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4462462084N0400X
AZ594752084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ993983Medicaid