Provider Demographics
NPI:1225038490
Name:JAISHANKAR, DEVAPIRAN (MD)
Entity type:Individual
Prefix:
First Name:DEVAPIRAN
Middle Name:
Last Name:JAISHANKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAISHANKAR
Other - Middle Name:
Other - Last Name:DEVAPIRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:900 E HILL AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37915-2565
Mailing Address - Country:US
Mailing Address - Phone:865-862-0998
Mailing Address - Fax:865-544-1861
Practice Address - Street 1:1410 TUSCULUM BLVD STE 2200
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-5822
Practice Address - Country:US
Practice Address - Phone:423-639-0243
Practice Address - Fax:423-639-0628
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN45463207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1225038490Medicaid
TN1517489Medicaid
TNP00877614OtherRAILROAD MEDICARE
TN1517489Medicaid
TN3709285Medicare UPIN
G31240Medicare UPIN