Provider Demographics
NPI:1508398264
Name:JAGANATHAN, DAISY (MD)
Entity Type:Individual
Prefix:DR
First Name:DAISY
Middle Name:
Last Name:JAGANATHAN
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 1:1721 BILLMAN LN
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-1419
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1014 OSWEGATCHIE TRAIL RD
Practice Address - Street 2:
Practice Address - City:STAR LAKE
Practice Address - State:NY
Practice Address - Zip Code:13690-3143
Practice Address - Country:US
Practice Address - Phone:315-848-3351
Practice Address - Fax:410-554-2184
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-31
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine