Healthcare Provider Details

I. General information

NPI: 1922425446
Provider Name (Legal Business Name): PREM JAYANTHAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2014
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7219 MCKNIGHT RD
PITTSBURGH PA
15237-3524
US

IV. Provider business mailing address

12210 PLUM ORCHARD DR STE 212
SILVER SPRING MD
20904-7913
US

V. Phone/Fax

Practice location:
  • Phone: 412-367-3278
  • Fax:
Mailing address:
  • Phone: 301-622-6020
  • Fax: 301-680-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0083581
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: