Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207T00000X | Neurosurgeon | MD464773 | PA |
NPI | 1073801130 |
---|---|
Provider Name | Dr. Ajit Sivananda Jada |
First Address | Paoli, PA 19301-1763 |
Second Address | Paoli, PA 19301 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2011 |
Last Update Date | 15/08/2018 |