Provider Demographics
NPI:1841278165
Name:NEHRA, AJAY (MD)
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:NEHRA
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 1:55 FRUIT ST BLDG 1102
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2621
Mailing Address - Country:US
Mailing Address - Phone:857-238-3838
Mailing Address - Fax:617-726-6131
Practice Address - Street 1:55 FRUIT ST BLDG 1102
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:857-238-3838
Practice Address - Fax:617-726-6131
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN38278208800000X
IL036-129932208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN078015400Medicaid
MN340010119OtherMEDICARE RAILROAD
MN340010119OtherMEDICARE RAILROAD
MN340000422Medicare PIN