Provider Demographics
NPI:1912904913
Name:NAIDU, AJIT KAMALAKARRAO (MD)
Entity Type:Individual
Prefix:
First Name:AJIT
Middle Name:KAMALAKARRAO
Last Name:NAIDU
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 1:2095 FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35630-2751
Mailing Address - Country:US
Mailing Address - Phone:256-766-2310
Mailing Address - Fax:256-768-9956
Practice Address - Street 1:2095 FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2751
Practice Address - Country:US
Practice Address - Phone:256-766-2310
Practice Address - Fax:256-768-9956
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15209R207RC0000X
FLME 97412207RC0000X
ALMD.29028207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL180882Medicaid
AL511-68536OtherBCBS AL
LAP00093128OtherRR MEDICARE
MS07107811Medicaid
LA1161233Medicaid
LA1161233Medicaid
AL102I066614Medicare PIN
LAP00093128OtherRR MEDICARE