Provider Demographics
NPI:1710976089
Name:ALAGARSAMY, JAYANTHI (MD)
Entity Type:Individual
Prefix:
First Name:JAYANTHI
Middle Name:
Last Name:ALAGARSAMY
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:PO BOX 932127
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44193-0008
Mailing Address - Country:US
Mailing Address - Phone:440-248-1297
Mailing Address - Fax:
Practice Address - Street 1:33001 SOLON RD
Practice Address - Street 2:#112
Practice Address - City:SOLON
Practice Address - State:OH
Practice Address - Zip Code:44139-2839
Practice Address - Country:US
Practice Address - Phone:440-248-1297
Practice Address - Fax:440-349-7131
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073679207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH110190912OtherRR MEDICARE
OH2064797Medicaid
OH2064797Medicaid
OHG75614Medicare UPIN