Provider Demographics
NPI:1730135229
Name:JAYARAMAN, ANU G (MD)
Entity type:Individual
Prefix:
First Name:ANU
Middle Name:G
Last Name:JAYARAMAN
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 1:95 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-3155
Mailing Address - Country:US
Mailing Address - Phone:781-762-5858
Mailing Address - Fax:
Practice Address - Street 1:95 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3155
Practice Address - Country:US
Practice Address - Phone:781-762-5858
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA227890207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2120461Medicaid
MA2120461Medicaid
MAA39984Medicare PIN