Provider Demographics
NPI:1255516548
Name:AJEY B GOLWALA, MD ,PC
Entity type:Organization
Organization Name:AJEY B GOLWALA, MD ,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AJEY
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLWALA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-787-5333
Mailing Address - Street 1:2500 BLUE RIDGE RD
Mailing Address - Street 2:SUITE 327
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607-6454
Mailing Address - Country:US
Mailing Address - Phone:919-787-5333
Mailing Address - Fax:919-567-0004
Practice Address - Street 1:2500 BLUE RIDGE RD
Practice Address - Street 2:SUITE 327
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607-6454
Practice Address - Country:US
Practice Address - Phone:919-787-5333
Practice Address - Fax:919-567-0004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207R00000X261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110105438OtherRR MEDICARE
NC36415OtherBCBS
NC8936145Medicaid
NC110105438OtherRR MEDICARE