Provider Demographics
NPI:1275740805
Name:JAGANNATHAN, JYOTHIPRIYA (MD)
Entity Type:Individual
Prefix:DR
First Name:JYOTHIPRIYA
Middle Name:
Last Name:JAGANNATHAN
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 1:75 FRANCIS ST
Mailing Address - Street 2:BRIGHAM AND WOMEN'S HOSPITAL, RADIOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:732-501-8896
Mailing Address - Fax:
Practice Address - Street 1:90 BYNNER ST
Practice Address - Street 2:#4
Practice Address - City:JAMAICA PLAIN
Practice Address - State:MA
Practice Address - Zip Code:02130-1001
Practice Address - Country:US
Practice Address - Phone:732-501-8896
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2266502085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000300601Medicare PIN