Provider Demographics
NPI:1134297450
Name:JAYANTHAN, NIRMALADEVI (MD)
Entity Type:Individual
Prefix:DR
First Name:NIRMALADEVI
Middle Name:
Last Name:JAYANTHAN
Suffix:
Gender:F
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:PO BOX 1828
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20604
Mailing Address - Country:US
Mailing Address - Phone:301-932-4954
Mailing Address - Fax:
Practice Address - Street 1:3328 OLD WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602
Practice Address - Country:US
Practice Address - Phone:301-932-4954
Practice Address - Fax:301-932-5095
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45737207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD161731100Medicaid
437MF382Medicare PIN