MEDICARE: DR. SANJEEV K. JAIRATH 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	207RG0100X	Gastroenterology Physician	0101046803	VA
2	174400000X	Specialist	0101046803	VA

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	:	1699776765
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SANJEEV K. JAIRATH MD

Provider Business Mailing Address
First Line	:	PO BOX 780125
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19178-0125
Country	:	US
Telephone Number	:	804-922-4844
Fax Number	:

Provider Business Practice Location Address
First Line	:	9105 STONY POINT DR
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23235-1979
Country	:	US
Telephone Number	:	804-828-4060
Fax Number	:	804-828-5348

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	04/19/2024

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