Provider Demographics
NPI:1902980857
Name:JAIRAJ, SUDHA (M D)
Entity Type:Individual
Prefix:
First Name:SUDHA
Middle Name:
Last Name:JAIRAJ
Suffix:
Gender:F
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 OLD YORK RD STE 301
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001-4626
Mailing Address - Country:US
Mailing Address - Phone:215-395-8266
Mailing Address - Fax:215-754-0989
Practice Address - Street 1:1021 OLD YORK RD STE 301
Practice Address - Street 2:
Practice Address - City:ABINGTON
Practice Address - State:PA
Practice Address - Zip Code:19001-4626
Practice Address - Country:US
Practice Address - Phone:215-395-8266
Practice Address - Fax:215-754-0989
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD037730L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0005533330001Medicaid
PAB33981Medicare UPIN
PA0005533330001Medicaid