Provider Demographics
NPI:1841279122
Name:JAYASWAL, BIJAY K (MD)
Entity type:Individual
Prefix:DR
First Name:BIJAY
Middle Name:K
Last Name:JAYASWAL
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 1:1220 MOORE RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-4044
Mailing Address - Country:US
Mailing Address - Phone:440-930-4446
Mailing Address - Fax:440-934-0682
Practice Address - Street 1:3457 MEDINA RD
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-9663
Practice Address - Country:US
Practice Address - Phone:330-721-2100
Practice Address - Fax:330-722-8142
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35042133207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000212710OtherANTHEM
OH0366741Medicaid
OH729OtherSUMMACARE
OH54208OtherQUALCHOICE
OH341221800036OtherCARESOUCE
OH729OtherSUMMACARE
OHA77542Medicare UPIN