Provider Demographics
NPI:1316301013
Name:JATEGAONKAR, AMEYA (MD)
Entity type:Individual
Prefix:
First Name:AMEYA
Middle Name:
Last Name:JATEGAONKAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 N 3RD AVE # 330
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4434
Mailing Address - Country:US
Mailing Address - Phone:602-406-8811
Mailing Address - Fax:602-406-8810
Practice Address - Street 1:2910 N 3RD AVE # 330
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4434
Practice Address - Country:US
Practice Address - Phone:602-406-8811
Practice Address - Fax:602-406-8810
Is Sole Proprietor?:No
Enumeration Date:2016-04-08
Last Update Date:2023-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ67177207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program