Provider Demographics
NPI:1861420861
Name:SUFI, AJAY S (MD)
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:S
Last Name:SUFI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4110 ASPEN HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-2853
Mailing Address - Country:US
Mailing Address - Phone:301-438-5150
Mailing Address - Fax:
Practice Address - Street 1:18111 PRINCE PHILIP DR
Practice Address - Street 2:T-20
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1513
Practice Address - Country:US
Practice Address - Phone:301-774-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00592932085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD401414600Medicaid
VA010073588Medicaid
DC034685300Medicaid
VA010073596Medicaid
VA010247501Medicaid
VA010073618Medicaid
VA010073669Medicaid
MD401414600Medicaid
VA010247501Medicaid
VA010073618Medicaid
P00603309Medicare PIN
VA010073146Medicare ID - Type UnspecifiedOLNEY
VA010073596Medicaid
VA010073588Medicaid