Provider Demographics
NPI:1538192703
Name:JYOTHINAGARAM, SATHYA G (MD,)
Entity type:Individual
Prefix:DR
First Name:SATHYA
Middle Name:G
Last Name:JYOTHINAGARAM
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 1:925 E MCDOWELL RD FL 3
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2502
Mailing Address - Country:US
Mailing Address - Phone:602-839-5895
Mailing Address - Fax:602-839-0589
Practice Address - Street 1:925 E MCDOWELL RD FL 3
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2502
Practice Address - Country:US
Practice Address - Phone:602-839-5895
Practice Address - Fax:602-839-0589
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC58662207RE0101X
AZ48182207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC110240775OtherRR MEDICARE
NC8947697Medicaid
NC47697OtherBCBS
NC5901374Medicaid
SCN00863Medicaid
NC47697OtherBCBS
NC5901374Medicaid
NCF56576Medicare UPIN
NC2201236KMedicare PIN