Basic Information
| Provider Information | |||||||||
| NPI: | 1508006859 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAJODIA | ||||||||
| FirstName: | ANILA | ||||||||
| MiddleName: | SHYAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3525 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 4330 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142556900 | ||||||||
| FaxNumber: | 6142556901 | ||||||||
| Practice Location | |||||||||
| Address1: | 3525 OLENTANGY RIVER RD | ||||||||
| Address2: | SUITE 4330 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432143937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142556900 | ||||||||
| FaxNumber: | 6142556901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2009 | ||||||||
| LastUpdateDate: | 02/08/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 35097030 | OH | N | Allopathic & Osteopathic Physicians | Hospitalist | 207QH0002X | 35097030 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0077745 | 05 | OH | MEDICAID |