MEDICARE: DR. NIRMALADEVI JAYANTHAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	D45737	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134297450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIRMALADEVI JAYANTHAN MD

Provider Business Mailing Address
First Line	:	PO BOX 1828
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20604
Country	:	US
Telephone Number	:	301-932-4954
Fax Number	:

Provider Business Practice Location Address
First Line	:	3328 OLD WASHINGTON RD
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20602
Country	:	US
Telephone Number	:	301-932-4954
Fax Number	:	301-932-5095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	03/06/2009

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