Provider Demographics
NPI:1336175884
Name:SOODAN, AJAY (MD)
Entity type:Individual
Prefix:DR
First Name:AJAY
Middle Name:
Last Name:SOODAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4000 OLD COURT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-2800
Mailing Address - Country:US
Mailing Address - Phone:410-521-5600
Mailing Address - Fax:410-655-4651
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-2800
Practice Address - Country:US
Practice Address - Phone:410-521-5600
Practice Address - Fax:410-655-4651
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2024-09-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0059401207RC0001X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH82691Medicare UPIN