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General NPI Number Information
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NPI Number | 1659576189
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Entity Type | Individual
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Provider Name | JAIRAM R ESWARA MD
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Gender | Male
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 11 NEVINS STREET SUITE 303
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City | BRIGHTON
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State | MA
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Zip | 02135
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Country | US
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Telephone | 617-787-8181
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Fax | 617-787-4644
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Provider Business Mailing Address
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Address Line | 960 MASSACHUSETTS AVE FL 2
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City | BOSTON
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State | MA
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Zip | 02118-2690
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 2013024713
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License Number State | MO
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