Provider Demographics
NPI:1083602155
Name:BHARADWAJ, JAYARAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYARAM
Middle Name:S
Last Name:BHARADWAJ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W ROMNEYA DR STE 203
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1824
Mailing Address - Country:US
Mailing Address - Phone:714-999-1465
Mailing Address - Fax:714-999-1701
Practice Address - Street 1:1801 W ROMNEYA DR STE 203
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1824
Practice Address - Country:US
Practice Address - Phone:714-999-1465
Practice Address - Fax:714-999-1701
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002001982207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND715415OtherMEDICARE
ND10090Medicaid
MO207308404Medicaid
MOP00730797OtherRAILROAD MEDICARE
AR177919001Medicaid
ND10090Medicaid
MO132680080Medicare PIN