Provider Demographics
NPI:1225038490
Name:JAISHANKAR, DEVAPIRAN (MD)
Entity Type:Individual
Prefix:
First Name:DEVAPIRAN
Middle Name:
Last Name:JAISHANKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAISHANKAR
Other - Middle Name:
Other - Last Name:DEVAPIRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:1 PROFESSIONAL PARK DR
Practice Address - Street 2:SUITE 21
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-6587
Practice Address - Country:US
Practice Address - Phone:423-232-6900
Practice Address - Fax:423-232-6903
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45463207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1225038490Medicaid
TN1517489Medicaid
TNP00877614OtherRAILROAD MEDICARE
TN1517489Medicaid
TN3709285Medicare UPIN
G31240Medicare UPIN