Provider Demographics
NPI:1548362486
Name:JEYAKUMAR, ANITA (MD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:JEYAKUMAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8423 MARKET ST STE 210
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-6778
Mailing Address - Country:US
Mailing Address - Phone:330-729-1934
Mailing Address - Fax:330-729-1861
Practice Address - Street 1:8423 MARKET ST STE 210
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-6778
Practice Address - Country:US
Practice Address - Phone:330-729-1934
Practice Address - Fax:330-729-1861
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.087978207YP0228X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2678115Medicaid