Provider Demographics
NPI:1841223377
Name:DHAR, UJJWAL (MD)
Entity type:Individual
Prefix:
First Name:UJJWAL
Middle Name:
Last Name:DHAR
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 23666
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-3666
Mailing Address - Country:US
Mailing Address - Phone:601-200-4749
Mailing Address - Fax:601-200-5929
Practice Address - Street 1:969 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4606
Practice Address - Country:US
Practice Address - Phone:601-200-4714
Practice Address - Fax:601-200-4718
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2016-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37134207R00000X, 207RI0200X
MS20776207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03900372Medicaid
TN29136OtherTLC
TN3328251Medicaid
TN4099087OtherBLUE CROSS BLUE SHIELD
MSP01059006OtherRAILROAD MEDICARE
P00213175Medicare ID - Type UnspecifiedRAILROAD MEDICARE
TN3328251Medicaid
I00752Medicare UPIN
MS302I443738Medicare PIN