Provider Demographics
NPI:1487654752
Name:VENKATARAMAN, JAYA (MD)
Entity Type:Individual
Prefix:DR
First Name:JAYA
Middle Name:
Last Name:VENKATARAMAN
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 1:3180 PROFESSIONAL PLAZA
Mailing Address - Street 2:SUITE 111
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138
Mailing Address - Country:US
Mailing Address - Phone:901-854-5455
Mailing Address - Fax:901-861-7736
Practice Address - Street 1:3180 PROFESSIONAL PLAZA
Practice Address - Street 2:SUITE 111
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138
Practice Address - Country:US
Practice Address - Phone:901-854-5455
Practice Address - Fax:901-861-7736
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38751207PP0204X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3339059Medicare PIN
TNF99456Medicare UPIN