Provider Demographics
NPI:1134548894
Name:AJMERA, KUNAL
Entity type:Individual
Prefix:
First Name:KUNAL
Middle Name:
Last Name:AJMERA
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 1:8813 WALTHAM WOODS RD STE 204
Mailing Address - Street 2:
Mailing Address - City:PARKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21234-2577
Mailing Address - Country:US
Mailing Address - Phone:312-806-0353
Mailing Address - Fax:
Practice Address - Street 1:8813 WALTHAM WOODS RD STE 204
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2577
Practice Address - Country:US
Practice Address - Phone:410-661-4670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD82404207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine