Provider Demographics
NPI:1548256332
Name:BAJWA, AJAY SINGH (MD)
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:SINGH
Last Name:BAJWA
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 1:2240 REMOUNT RD
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-4725
Mailing Address - Country:US
Mailing Address - Phone:704-671-5311
Mailing Address - Fax:704-671-5308
Practice Address - Street 1:2555 COURT DR
Practice Address - Street 2:SUITE 200
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2134
Practice Address - Country:US
Practice Address - Phone:704-867-2141
Practice Address - Fax:704-867-2308
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200490207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN00494Medicaid
NCP00223116OtherRAILROAD MEDICARE
NC89131NPMedicaid
SCN00494Medicaid
NC2002550AMedicare PIN