Provider Demographics
NPI:1639665631
Name:JAGANATHAN, ABILASH (MD)
Entity Type:Individual
Prefix:DR
First Name:ABILASH
Middle Name:
Last Name:JAGANATHAN
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 1:737 W CHILDS AVE
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95341-6805
Mailing Address - Country:US
Mailing Address - Phone:209-384-6493
Mailing Address - Fax:209-359-2045
Practice Address - Street 1:1100 DELBON AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2021
Practice Address - Country:US
Practice Address - Phone:866-682-4842
Practice Address - Fax:209-667-0922
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA174142208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics