Provider Demographics
NPI:1265433163
Name:PARIKH, JAYLAN R (MD)
Entity type:Individual
Prefix:MR
First Name:JAYLAN
Middle Name:R
Last Name:PARIKH
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 1:721 TILGHMAN DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DUNN
Mailing Address - State:NC
Mailing Address - Zip Code:28334-6066
Mailing Address - Country:US
Mailing Address - Phone:910-891-4202
Mailing Address - Fax:910-891-2602
Practice Address - Street 1:721 TILGHMAN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6066
Practice Address - Country:US
Practice Address - Phone:910-891-4202
Practice Address - Fax:910-891-2602
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC95-01044207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0938858OtherUHC
NC8965248Medicaid
NC65248OtherBSBC NC
NC65248OtherBSBC NC
NC8965248Medicaid