Individual
SHRUTHI N JAYARAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2010 OLD WEST CHESTER PIKE, SUITE 330, HAVERTOWN, PA 19083-2712
(610) 789-8070
(610) 789-9937
Mailing address
PO BOX 650782, DALLAS, TX 75265-0782
(610) 789-8070
(610) 789-9937
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
MD420440
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001915811
—
PA
01
—
11879715
CAQH
—
01
—
2117899000
KHPE
—
Enumeration date
10/26/2005
Last updated
12/16/2008
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