Basic Information
| Provider Information | |||||||||
| NPI: | 1528188034 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KARTHIKEYAN | ||||||||
| FirstName: | JEYAVARNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 MONARCH PL | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011441099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137342000 | ||||||||
| FaxNumber: | 4137348000 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 MONARCH PL | ||||||||
| Address2: | 10TH FLOOR | ||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 011441099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4137342000 | ||||||||
| FaxNumber: | 4137348000 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2007 | ||||||||
| LastUpdateDate: | 07/02/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | 242087 | MA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 110083580A | 05 | MA | MEDICAID |