| Jayanthan.m.d.,p.a | |
|
3328 Old Washington Rd Waldorf MD 20602-3204 | |
| (301) 932-4954 | |
| (301) 932-5095 |
| Full Name | Jayanthan.m.d.,p.a |
|---|---|
| Speciality | Internal Medicine |
| Location | 3328 Old Washington Rd, Waldorf, Maryland |
| Authorized Official Name and Position | Nirmaladevi Jayanthan (PRESIDENT) |
| Authorized Official Contact | 3019324954 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jayanthan.m.d.,p.a 3328 Old Washington Rd Waldorf MD 20602-3204 Ph: (301) 932-4954 | Jayanthan.m.d.,p.a 3328 Old Washington Rd Waldorf MD 20602-3204 Ph: (301) 932-4954 |
| NPI Number | 1316111651 |
|---|---|
| Provider Enumeration Date | 04/17/2008 |
| Last Update Date | 03/06/2009 |
| Medicare PECOS PAC ID | 7113996794 |
|---|---|
| Medicare Enrollment ID | O20051017000314 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316111651 | NPI | - | NPPES |
| 400866900 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | D45737 (Maryland) | Primary |
| Provider Name | Nirmaladevi Jayanthan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134297450 PECOS PAC ID: 1557330131 Enrollment ID: I20051117000281 |
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