Provider Demographics
NPI:1457466567
Name:JAYARAMAN, VENKATESH BABU (MD)
Entity Type:Individual
Prefix:
First Name:VENKATESH
Middle Name:BABU
Last Name:JAYARAMAN
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 1:346 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-2580
Mailing Address - Country:US
Mailing Address - Phone:607-729-8156
Mailing Address - Fax:607-729-3982
Practice Address - Street 1:27 PARK AVE
Practice Address - Street 2:FIFTH FLOOR
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-1605
Practice Address - Country:US
Practice Address - Phone:607-762-2251
Practice Address - Fax:607-762-2269
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY263467207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
05208715OtherECFMG #
NY02796472Medicaid
05208715OtherECFMG #