Provider Demographics
NPI:1548226582
Name:SATHIANATHAN, JAIRUS (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIRUS
Middle Name:
Last Name:SATHIANATHAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAIRUS
Other - Middle Name:
Other - Last Name:SATHIANATHAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2570 NW EDENBOWER BLVD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97471-6214
Mailing Address - Country:US
Mailing Address - Phone:541-677-7200
Mailing Address - Fax:541-229-3309
Practice Address - Street 1:1937 W HARVARD AVE
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97471-2720
Practice Address - Country:US
Practice Address - Phone:541-677-7200
Practice Address - Fax:541-229-3309
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25568208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR844477029OtherBCBS-GRANTS PASS
ORP00237173OtherRAIL ROAD MEDICARE
OR026829Medicaid
OR838366027OtherBCBS-MCMINNVILLE
OR838334026OtherBCBS-ROSEBURG
ORR132150Medicare PIN
OR838366027OtherBCBS-MCMINNVILLE
OR844477029OtherBCBS-GRANTS PASS
ORI37288Medicare UPIN
ORP00237173OtherRAIL ROAD MEDICARE