Provider Demographics
NPI:1528188034
Name:KARTHIKEYAN, JEYAVARNA (MD)
Entity Type:Individual
Prefix:DR
First Name:JEYAVARNA
Middle Name:
Last Name:KARTHIKEYAN
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 1:1 MONARCH PL
Mailing Address - Street 2:10TH FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01144-1099
Mailing Address - Country:US
Mailing Address - Phone:413-734-2000
Mailing Address - Fax:413-734-8000
Practice Address - Street 1:1 MONARCH PL
Practice Address - Street 2:10TH FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01144-1099
Practice Address - Country:US
Practice Address - Phone:413-734-2000
Practice Address - Fax:413-734-8000
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA242087208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110083580AMedicaid
MA110083580AMedicaid