Provider Demographics
NPI:1770518714
Name:MADHURE, JAY B (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:B
Last Name:MADHURE
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 1:16281 SAN FERNANDO MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-3725
Mailing Address - Country:US
Mailing Address - Phone:818-838-4600
Mailing Address - Fax:818-366-7479
Practice Address - Street 1:16281 SAN FERNANDO MISSION BLVD
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-3725
Practice Address - Country:US
Practice Address - Phone:818-838-4600
Practice Address - Fax:818-366-7479
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33612207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A336121Medicaid
CAA33612Medicare ID - Type Unspecified
CAA27195Medicare UPIN