Provider Demographics
NPI:1104269760
Name:JEYAKUMAR, THANUJA (MD)
Entity type:Individual
Prefix:DR
First Name:THANUJA
Middle Name:
Last Name:JEYAKUMAR
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5686 BROADVIEW RD
Mailing Address - Street 2:APT 2507
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-1655
Mailing Address - Country:US
Mailing Address - Phone:216-280-0456
Mailing Address - Fax:
Practice Address - Street 1:5686 BROADVIEW RD
Practice Address - Street 2:APT 2507
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-1655
Practice Address - Country:US
Practice Address - Phone:216-280-0456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-14
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA106328002085R0202X
390200000X
WAMD611156952085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program