Provider Demographics
NPI:1003899386
Name:JAIN, JITENDRA A (MD)
Entity Type:Individual
Prefix:DR
First Name:JITENDRA
Middle Name:A
Last Name:JAIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:102 ESSEX CT
Mailing Address - Street 2:STE A
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-3160
Mailing Address - Country:US
Mailing Address - Phone:256-461-8442
Mailing Address - Fax:256-461-8447
Practice Address - Street 1:102 ESSEX CT
Practice Address - Street 2:STE A
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758
Practice Address - Country:US
Practice Address - Phone:256-461-8442
Practice Address - Fax:256-461-8447
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL21602208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009962215Medicaid
AL51522575OtherBCBS OF ALABAMA
AL51522575OtherBCBS OF ALABAMA