Provider Demographics
NPI:1720156144
Name:JAYANTHI, VIMALA V (MD)
Entity Type:Individual
Prefix:DR
First Name:VIMALA
Middle Name:V
Last Name:JAYANTHI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW STE 2-122
Mailing Address - Street 2:GEORGE WASHINGTON UNIV- MEDICAL FACULTY ASSOCIATES
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-2200
Mailing Address - Fax:202-741-2185
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW STE 2-122
Practice Address - Street 2:GEORGE WASHINGTON UNIV- MEDICAL FACULTY ASSOCIATES
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2200
Practice Address - Fax:202-741-2185
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056770207R00000X
DCMD31446207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC039284500Medicaid
MD4138309Medicaid
VA1720156144Medicaid
007270M92Medicare ID - Type Unspecified
DC039284500Medicaid