Provider Demographics
NPI:1982955142
Name:SELVAM, JEYANDRA (MD)
Entity Type:Individual
Prefix:
First Name:JEYANDRA
Middle Name:
Last Name:SELVAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JEYANDRA
Other - Middle Name:
Other - Last Name:MEGANATHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:136 LINDEN DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6900
Mailing Address - Country:US
Mailing Address - Phone:540-678-3588
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:1840 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-2808
Practice Address - Country:US
Practice Address - Phone:540-536-2270
Practice Address - Fax:540-536-7847
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101258196208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP01545523OtherRR MEDICARE
VAVV1872AMedicare PIN