Provider Demographics
NPI:1790348423
Name:JEYAMURUGAN, KOKILA (MD)
Entity Type:Individual
Prefix:
First Name:KOKILA
Middle Name:
Last Name:JEYAMURUGAN
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 1:18 OLD RUDNICK LN
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-4912
Mailing Address - Country:US
Mailing Address - Phone:302-674-2616
Mailing Address - Fax:
Practice Address - Street 1:18 OLD RUDNICK LN
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4912
Practice Address - Country:US
Practice Address - Phone:302-674-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0024832208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty