Provider Demographics
NPI:1861426181
Name:JAYAGOPALAN, RAMKUMAR (MD)
Entity type:Individual
Prefix:
First Name:RAMKUMAR
Middle Name:
Last Name:JAYAGOPALAN
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 1:2113 ADAMS GRV
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6951
Mailing Address - Country:US
Mailing Address - Phone:803-256-0531
Mailing Address - Fax:803-765-9052
Practice Address - Street 1:2113 ADAMS GRV
Practice Address - Street 2:SUITE 101
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6951
Practice Address - Country:US
Practice Address - Phone:803-256-0531
Practice Address - Fax:803-765-9052
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2011-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27040208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCRHC504Medicaid
SCRHC504Medicaid