Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | MD035435L | PA |
N | 207R00000X | Internist | MD035435L | PA |
N | 111NI0900X | Internist | MD035435L | PA |
N | 208200000X | Surgeon | MD035435L | PA |
N | 208600000X | Surgeon | MD035435L | PA |
NPI | 1003808734 |
---|---|
Provider Name | Dr. Suryanarayan Jairaj |
First Address | Abington, PA 19001 |
Second Address | Miramar, FL 33027-6308 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2005 |
Last Update Date | 17/05/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0007208430001 | (05) | PA |
C28594 | (02) |