MEDICARE: MAYURI SUNIL JAGIRDAR 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	4301096667	MI
2	207R00000X	Internal Medicine Physician	153558	CA

General Provider Information

NPI Number	:	1235443946
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYURI SUNIL JAGIRDAR MD

Provider Business Mailing Address
First Line	:	2670 S WHITE RD STE 200
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95148-2073
Country	:	US
Telephone Number	:	408-729-4290
Fax Number	:

Provider Business Practice Location Address
First Line	:	1066 S WHITE RD
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95127-3812
Country	:	US
Telephone Number	:	408-755-3800
Fax Number	:

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

Provider Enumeration Date	:	08/05/2010
Last Update Date	:	02/03/2022

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