Healthcare Provider Details

I. General information

NPI: 1295389591
Provider Name (Legal Business Name): JEEVA JAGANATHAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2019
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 W SILVER ST
WESTFIELD MA
01085-3678
US

IV. Provider business mailing address

280 CHESTNUT ST FL 2
SPRINGFIELD MA
01199-1001
US

V. Phone/Fax

Practice location:
  • Phone: 413-572-6069
  • Fax: 413-562-4975
Mailing address:
  • Phone: 413-794-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number1026163
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: