Provider Demographics
NPI:1144279951
Name:JAYARAM, ATTIGUPAM R (MD)
Entity type:Individual
Prefix:DR
First Name:ATTIGUPAM
Middle Name:R
Last Name:JAYARAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1250 CONCANNON BLVD
Mailing Address - Street 2:
Mailing Address - City:LIVERMORE
Mailing Address - State:CA
Mailing Address - Zip Code:94550-6002
Mailing Address - Country:US
Mailing Address - Phone:925-455-5914
Mailing Address - Fax:925-455-5020
Practice Address - Street 1:1250 CONCANNON BLVD
Practice Address - Street 2:
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-6002
Practice Address - Country:US
Practice Address - Phone:925-455-5914
Practice Address - Fax:925-455-5020
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-09
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA259872084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3012516Medicaid
CAA86995Medicare UPIN
CA3012516Medicaid