Individual
SANJAY JAGANNATH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2601 LAKE DR, RALEIGH, NC 27607-6688
(919) 783-4888
(919) 783-4887
Mailing address
PO BOX 18563, RALEIGH, NC 27619-8563
(919) 783-4887
(919) 783-4887
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
2015-02088
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
983200900
—
MD
Enumeration date
05/27/2006
Last updated
11/19/2015
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