Provider Demographics
NPI:1992233787
Name:JAIRATH, ASHISH (MD)
Entity type:Individual
Prefix:
First Name:ASHISH
Middle Name:
Last Name:JAIRATH
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:MEDICAL CENTER BOULEVARD
Mailing Address - Street 2:DEPARTMENT OF RADIOLOGY, WAKE FOREST SCHOOL OF MEDICINE
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27157-1088
Mailing Address - Country:US
Mailing Address - Phone:336-716-2471
Mailing Address - Fax:336-716-0555
Practice Address - Street 1:MEDICAL CENTER BOULEVARD
Practice Address - Street 2:DEPARTMENT OF RADIOLOGY, WAKE FOREST SCHOOL OF MEDICINE
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-1088
Practice Address - Country:US
Practice Address - Phone:336-716-2471
Practice Address - Fax:336-716-0555
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2018-01-10
Deactivation Date:2017-12-28
Deactivation Code:
Reactivation Date:2018-01-10
Provider Licenses
StateLicense IDTaxonomies
390200000X
NC226033390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program