Provider Demographics
NPI:1942349816
Name:JAYARAMAN MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:JAYARAMAN MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:P
Authorized Official - Last Name:JAYARAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-884-8161
Mailing Address - Street 1:28227 THREE NOTCH RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-3239
Mailing Address - Country:US
Mailing Address - Phone:301-884-8161
Mailing Address - Fax:301-475-7039
Practice Address - Street 1:28227 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-3239
Practice Address - Country:US
Practice Address - Phone:301-884-8161
Practice Address - Fax:301-475-7039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0020177174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403248900Medicaid
MD403248900Medicaid