Provider Demographics
NPI:1811905961
Name:NANAVATI, AJAY (MD)
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:
Last Name:NANAVATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9 KITSON PARK DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-8109
Mailing Address - Country:US
Mailing Address - Phone:603-557-7034
Mailing Address - Fax:617-636-4822
Practice Address - Street 1:4 COURTHOUSE LN UNIT 1-3
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-1728
Practice Address - Country:US
Practice Address - Phone:978-293-0089
Practice Address - Fax:617-636-4822
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12534207R00000X
MA220686207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090585AMedicaid
NH30204715Medicaid
RE 7961Medicare ID - Type Unspecified