Healthcare Provider Details

I. General information

NPI: 1770717076
Provider Name (Legal Business Name): CHELLAPANDIAN JEYARAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2009
Last Update Date: 05/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 MERRYTON ST
VOORHEES NJ
08043-4332
US

IV. Provider business mailing address

19 MERRYTON ST
VOORHEES NJ
08043-4332
US

V. Phone/Fax

Practice location:
  • Phone: 856-784-7224
  • Fax: 856-784-7224
Mailing address:
  • Phone: 856-784-7224
  • Fax: 856-784-7224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number25MA02840100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: