Provider Demographics
NPI:1669411476
Name:DAS, AJIT KUMAR (MD)
Entity type:Individual
Prefix:
First Name:AJIT
Middle Name:KUMAR
Last Name:DAS
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:PO BOX 62063
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2063
Mailing Address - Country:US
Mailing Address - Phone:410-706-5181
Mailing Address - Fax:410-706-5103
Practice Address - Street 1:827 LINDEN AVE FL 1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4606
Practice Address - Country:US
Practice Address - Phone:410-225-8780
Practice Address - Fax:410-225-8766
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0032132208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD375031100Medicaid
DCS2560010OtherDC BLUE CROSS #
MD399690-04OtherCAREFIRST BCBS #
MD399690-04OtherCAREFIRST BCBS #
MDAD3108176OtherDEA #