Healthcare Provider Details

I. General information

NPI: 1841279122
Provider Name (Legal Business Name): BIJAY K. JAYASWAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2006
Last Update Date: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3457 MEDINA RD
MEDINA OH
44256-9663
US

IV. Provider business mailing address

1220 MOORE RD SUITE B
AVON OH
44011-4044
US

V. Phone/Fax

Practice location:
  • Phone: 330-721-2100
  • Fax: 330-722-8142
Mailing address:
  • Phone: 440-930-4446
  • Fax: 440-934-0682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35042133
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: