Provider Demographics
NPI:1063130490
Name:JAYARAM, NIKHIL BUSH
Entity type:Individual
Prefix:
First Name:NIKHIL BUSH
Middle Name:
Last Name:JAYARAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SAINT PAUL ST APT NO813
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-2703
Mailing Address - Country:US
Mailing Address - Phone:443-248-6664
Mailing Address - Fax:
Practice Address - Street 1:1830 E MONUMENT ST # 406
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-0020
Practice Address - Country:US
Practice Address - Phone:443-248-6664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program