Provider Demographics
NPI:1285188383
Name:JIVRAJ, IMRAN (MD, FRCSC)
Entity Type:Individual
Prefix:DR
First Name:IMRAN
Middle Name:
Last Name:JIVRAJ
Suffix:
Gender:M
Credentials:MD, FRCSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 CHESTNUT ST
Mailing Address - Street 2:APT 809
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-7702
Mailing Address - Country:US
Mailing Address - Phone:215-917-2072
Mailing Address - Fax:
Practice Address - Street 1:3737 CHESTNUT ST
Practice Address - Street 2:APT 809
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104-7702
Practice Address - Country:US
Practice Address - Phone:215-917-2072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ119758207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology