Provider Demographics
NPI:1396883773
Name:HANSALIA, AJIT VALLABHDAS (MD)
Entity type:Individual
Prefix:
First Name:AJIT
Middle Name:VALLABHDAS
Last Name:HANSALIA
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 1:901 N GROVE ST
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-2805
Mailing Address - Country:US
Mailing Address - Phone:352-508-7040
Mailing Address - Fax:
Practice Address - Street 1:901 N GROVE ST
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-2805
Practice Address - Country:US
Practice Address - Phone:352-508-7040
Practice Address - Fax:352-433-0525
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79827207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH17435Medicare UPIN