Healthcare Provider Details

I. General information

NPI: 1558548156
Provider Name (Legal Business Name): KRISHNARAJ JAYARAMA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2008
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 OLD FAIRHAVEN PKWY STE 201
BELLINGHAM WA
98225-7446
US

IV. Provider business mailing address

1820 KELLY RD
BELLINGHAM WA
98226-7508
US

V. Phone/Fax

Practice location:
  • Phone: 732-762-9372
  • Fax:
Mailing address:
  • Phone: 732-762-9372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25MB08253300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number60774163
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number2008-00763
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: