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General NPI Number Information
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NPI Number | 1922425446
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Entity Type | Individual
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Provider Name | PREM JAYANTHAN D.O.
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Gender | Male
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Dates
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Enumeration Date | 03/21/2014
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Last Update Date | 12/15/2025
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Provider Practice Location Address
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Address Line | 7219 MCKNIGHT RD
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City | PITTSBURGH
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State | PA
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Zip | 15237-3524
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Country | US
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Telephone | 412-367-3278
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Fax |
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Provider Business Mailing Address
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Address Line | 12210 PLUM ORCHARD DR STE 212
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City | SILVER SPRING
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State | MD
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Zip | 20904-7913
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Country | US
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Telephone | 301-622-6020
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Fax | 301-680-9335
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | H0083581
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License Number State | MD
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