MEDICARE: DR. ARCHANA JAYARAM 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
1	2080N0001X	Neonatal-Perinatal Medicine Physician	0101244757	VA

General Provider Information

NPI Number	:	1659517159
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ARCHANA JAYARAM M.D.

Provider Business Mailing Address
First Line	:	12114 HEATHERFORD PL
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23059-7140
Country	:	US
Telephone Number	:	804-873-8252
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 E MARSHALL ST
Second Line	:	NORTH HOSPITAL, 6TH FLOOR, ROOM 6-020
City	:	RICHMOND
State	:	VA
Zip	:	23298-5051
Country	:	US
Telephone Number	:	804-828-9964
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	11/13/2012

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