Healthcare Provider Details

I. General information

NPI: 1760682512
Provider Name (Legal Business Name): JAYANTHI NAGENDRA KONERU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JAY KONERU M.D

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 03/06/2024
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST INTERNAL MEDICINE
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

1200 E MARSHALL ST
RICHMOND VA
23298
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-0147
  • Fax: 804-827-1011
Mailing address:
  • Phone: 804-628-0734
  • Fax: 804-342-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101251764
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number0101251764
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: