Provider Demographics
NPI:1548333636
Name:DIRGHANGI, JAYANTA KUMAR (MD)
Entity type:Individual
Prefix:DR
First Name:JAYANTA
Middle Name:KUMAR
Last Name:DIRGHANGI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37174
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3174
Mailing Address - Country:US
Mailing Address - Phone:571-423-5699
Mailing Address - Fax:571-423-5698
Practice Address - Street 1:22505 LANDMARK CT STE 210B
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-6500
Practice Address - Country:US
Practice Address - Phone:571-612-6350
Practice Address - Fax:571-612-6351
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD12656174400000X
VA0101271612207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN621415063OtherTAX ID
TN621415063OtherTAX ID
TN3184574Medicare ID - Type UnspecifiedMEDICARE #