Provider Demographics
NPI:1174619795
Name:KADAKIA, AJAY S (MD)
Entity type:Individual
Prefix:DR
First Name:AJAY
Middle Name:S
Last Name:KADAKIA
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 1:108 E NORTHWOOD ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1310
Mailing Address - Country:US
Mailing Address - Phone:336-574-2100
Mailing Address - Fax:336-574-1260
Practice Address - Street 1:108 E NORTHWOOD ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1310
Practice Address - Country:US
Practice Address - Phone:336-574-2100
Practice Address - Fax:336-574-1260
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501293207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9501293OtherSTATE LICENSE
NC8947727Medicaid
NC9501293OtherSTATE LICENSE
NC8947727Medicaid