Provider Demographics
NPI:1134932643
Name:DANIEL EZHILARASU, SELVIN THEODORE JAYA (MD)
Entity type:Individual
Prefix:
First Name:SELVIN THEODORE JAYA
Middle Name:
Last Name:DANIEL EZHILARASU
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 1:838 E LIVINGSTON AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-2651
Mailing Address - Country:US
Mailing Address - Phone:614-483-0900
Mailing Address - Fax:
Practice Address - Street 1:700 CHILDRENS DR STE 6B.1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-2639
Practice Address - Country:US
Practice Address - Phone:614-483-0900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPP0007749632088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric Urology