Healthcare Provider Details

I. General information

NPI: 1720604283
Provider Name (Legal Business Name): GEERTHANA JEYAKUMAR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 CORINNE CRESCENT
TORONTO ONTARIO
M1K2Y9
CA

IV. Provider business mailing address

28 CORINNE CRESCENT
TORONTO ONTARIO
M1K 2Y9
CA

V. Phone/Fax

Practice location:
  • Phone: 757-337-7734
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101276751
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: