Healthcare Provider Details

I. General information

NPI: 1982955142
Provider Name (Legal Business Name): JEYANDRA SELVAM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEYANDRA MEGANATHAN M.D.

II. Dates (important events)

Enumeration Date: 09/27/2012
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 AMHERST ST
WINCHESTER VA
22601-2808
US

IV. Provider business mailing address

136 LINDEN DR SUITE 104
WINCHESTER VA
22601-6900
US

V. Phone/Fax

Practice location:
  • Phone: 540-536-2270
  • Fax: 540-536-7847
Mailing address:
  • Phone: 540-678-3588
  • Fax: 540-678-9025

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101258196
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101258196
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: