1215072301 NPI number — JAYASREE JAYADEVAN NANDAGOPAL MD

Table of content: JAYASREE JAYADEVAN NANDAGOPAL MD (NPI 1215072301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215072301 NPI number — JAYASREE JAYADEVAN NANDAGOPAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NANDAGOPAL
Provider First Name:
JAYASREE
Provider Middle Name:
JAYADEVAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215072301
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2070 WINDING CREEK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MASON
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45040-1451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-868-1562
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7760 UNIVERSITY CT
Provider Second Line Business Practice Location Address:
SUITE H
Provider Business Practice Location Address City Name:
WEST CHESTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45069-3371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-547-4491
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  35.088216 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1215072301 . This is a "ALLIANCE SELECT" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1215072301 . This is a "MEDICAL MUTUAL" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1215072301 . This is a "UNITED BEHAVIORAL HEALTH (UBH)" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 272314123 . This is a "LIFESYNCH - HUMANA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1215072301 . This is a "BEECH STREET" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1215072301 . This is a "CONCERN - TRI HEALTH" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2726054 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000663376 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1215072301 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1215072301 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1215072301 . This is a "TRI STATE BENEFITS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1215072301 . This is a "HEALTH SPAN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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