Provider Demographics
NPI:1891807194
Name:JAYMA, FERNANDO Y (MD)
Entity Type:Individual
Prefix:DR
First Name:FERNANDO
Middle Name:Y
Last Name:JAYMA
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 1:15 HUBBARD ST
Mailing Address - Street 2:
Mailing Address - City:LUDLOW
Mailing Address - State:MA
Mailing Address - Zip Code:01056-2756
Mailing Address - Country:US
Mailing Address - Phone:413-583-8980
Mailing Address - Fax:413-589-1184
Practice Address - Street 1:15 HUBBARD ST
Practice Address - Street 2:
Practice Address - City:LUDLOW
Practice Address - State:MA
Practice Address - Zip Code:01056-2756
Practice Address - Country:US
Practice Address - Phone:413-583-8980
Practice Address - Fax:413-589-1184
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA51728208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6174108Medicaid
MA(JA)J02811Medicare ID - Type Unspecified
MA6174108Medicaid