Provider Demographics
NPI:1982636700
Name:CHAWLA, AJAY (MD)
Entity Type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:CHAWLA
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 1:2356 WOODLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44903-8586
Mailing Address - Country:US
Mailing Address - Phone:419-747-6164
Mailing Address - Fax:
Practice Address - Street 1:110 AUBURN AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:SHELBY
Practice Address - State:OH
Practice Address - Zip Code:44875-1104
Practice Address - Country:US
Practice Address - Phone:419-342-4242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079605C207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00169283OtherRR MEDICARE
OH2254712OtherCIGNA
OH2264866Medicaid
OH000000340883OtherANTHEM
OH2254712OtherCIGNA
OHP00169283OtherRR MEDICARE