Basic Information
| Provider Information | |||||||||
| NPI: | 1508398264 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAGANATHAN | ||||||||
| FirstName: | DAISY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1721 BILLMAN LN | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209021419 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1014 OSWEGATCHIE TRAIL RD | ||||||||
| Address2: | |||||||||
| City: | STAR LAKE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136903143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3158483351 | ||||||||
| FaxNumber: | 4105542184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2017 | ||||||||
| LastUpdateDate: | 09/29/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 307253 | NY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.