Provider Demographics
NPI:1154527521
Name:PHATAK, AJINKYA VIKRAM (MD)
Entity type:Individual
Prefix:
First Name:AJINKYA
Middle Name:VIKRAM
Last Name:PHATAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1555 LONG POND ROAD
Mailing Address - Street 2:HOSPITALIST PROGRAM
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14626-4122
Mailing Address - Country:US
Mailing Address - Phone:585-723-7000
Mailing Address - Fax:585-723-7871
Practice Address - Street 1:1555 LONG POND ROAD
Practice Address - Street 2:HOSPITALIST PROGRAM
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14626
Practice Address - Country:US
Practice Address - Phone:585-723-7000
Practice Address - Fax:585-723-7871
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY295560208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist