Provider Demographics
NPI:1851312870
Name:PAI, JEEVAN JAGDISH (MD)
Entity Type:Individual
Prefix:
First Name:JEEVAN
Middle Name:JAGDISH
Last Name:PAI
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 1:9555 BROOKCHASE DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7349
Mailing Address - Country:US
Mailing Address - Phone:919-806-2758
Mailing Address - Fax:
Practice Address - Street 1:115 KILDAIRE PARK DR STE 201
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-8144
Practice Address - Country:US
Practice Address - Phone:919-816-4948
Practice Address - Fax:919-233-7685
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2006-00212207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I35694Medicare UPIN