Provider Demographics
NPI:1386755403
Name:VERMA, AJAY K (MD)
Entity type:Individual
Prefix:
First Name:AJAY
Middle Name:K
Last Name:VERMA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1555 EAST ST
Practice Address - Street 2:SUITE 230
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1153
Practice Address - Country:US
Practice Address - Phone:530-244-7400
Practice Address - Fax:530-244-7800
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-03-25
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Provider Licenses
StateLicense IDTaxonomies
CAA434390207RH0003X
CAA43439207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1928052OtherCIGNA
CA00A434390OtherBLUE SHIELD
CAP01138609OtherRAILROAD MCR
CA00A434390Medicaid
CAA29695Medicare UPIN
CA00A434390Medicaid
CA00A434392Medicare PIN