Healthcare Provider Details

I. General information

NPI: 1720570005
Provider Name (Legal Business Name): ATPUTHANATHAN RICHARD JEYARANJAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1585 MARKHAM ROAD SUITE 302
SCARBOROUGH ONTARIO
M1B2W1
CA

IV. Provider business mailing address

47 BENTWORTH AVENUE
TORONTO ONTARIO
M6A1P1
CA

V. Phone/Fax

Practice location:
  • Phone: 416-222-8004
  • Fax: 416-332-9359
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD049151L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: