Provider Demographics
NPI:1720570005
Name:JEYARANJAN, ATPUTHANATHAN RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ATPUTHANATHAN
Middle Name:RICHARD
Last Name:JEYARANJAN
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 1:47 BENTWORTH AVENUE
Mailing Address - Street 2:
Mailing Address - City:TORONTO
Mailing Address - State:ONTARIO
Mailing Address - Zip Code:M6A1P1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1585 MARKHAM ROAD
Practice Address - Street 2:SUITE 302
Practice Address - City:SCARBOROUGH
Practice Address - State:ONTARIO
Practice Address - Zip Code:M1B2W1
Practice Address - Country:CA
Practice Address - Phone:416-222-8004
Practice Address - Fax:416-332-9359
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049151L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD049151LOtherINTERNAL MEDICINE