Provider Demographics
NPI:1194721647
Name:JAYARAMAN, NILIMA K (MD)
Entity type:Individual
Prefix:DR
First Name:NILIMA
Middle Name:K
Last Name:JAYARAMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28470 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20659-3455
Mailing Address - Country:US
Mailing Address - Phone:301-884-5543
Mailing Address - Fax:
Practice Address - Street 1:28227 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20659-3239
Practice Address - Country:US
Practice Address - Phone:301-884-8161
Practice Address - Fax:301-475-7039
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031344208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD403248900Medicaid
MD591M937FMedicare ID - Type UnspecifiedMEDICARE PROV #