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NPI Code Detail

MEDICARE: DR. KASTHURI E JAYARAJ M.D.

MEDICARE: DR. KASTHURI E JAYARAJ M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine Physician25MA04983700NJ
2207R00000XInternal Medicine PhysicianME110369FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1008837B1FOTHERNJMEDICARE BILLING NUMBER

General Provider Information

NPI Number : 1275578619
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KASTHURI E JAYARAJ M.D.
Provider Business Mailing Address
First Line : 700 8TH AVE W STE 101
Second Line :
City : PALMETTO
State : FL
Zip : 34221-4737
Country : US
Telephone Number : 941-776-4000
Fax Number : 941-845-4963
Provider Business Practice Location Address
First Line : 1312 MANATEE AVE E
Second Line :
City : BRADENTON
State : FL
Zip : 34208-1358
Country : US
Telephone Number : 941-708-8700
Fax Number : 941-708-8738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2006
Last Update Date : 03/17/2018

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