NPIMap

Organization Active NPI

Supriya Jagannath MD LLC

  • Anesthesiology Physician
  • Frederick, MD
National Provider Identifier
1053635284
Registry record updated Mar 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
D0064112 Issued in MD
Legal business name
SUPRIYA JAGANNATH MD LLC
Practice address
9657 Atterbury LN
Frederick, MD 21704-7400
Phone
(410) 476-7511
NPI assigned
Mar 17, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Supriya Banad Jagannath, MDNPI 1164464434
Title
Owner
Phone
(410) 476-7511

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207L00000X D0064112 MD Primary

Addresses

Primary practice location

9657 Atterbury LN
Frederick, MD 21704-7400

Mailing address

9657 Atterbury LN
Frederick, MD 21704-7400
Phone (410) 476-7511

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268784000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268784000000",
    "number": "1053635284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9657 ATTERBURY LN",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217047400",
            "telephone_number": "410-476-7511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9657 ATTERBURY LN",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217047400",
            "telephone_number": "410-476-7511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPRIYA JAGANNATH MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-17",
        "last_updated": "2010-03-17",
        "status": "A",
        "authorized_official_last_name": "JAGANNATH",
        "authorized_official_first_name": "SUPRIYA",
        "authorized_official_middle_name": "BANAD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-476-7511",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "MD",
            "license": "D0064112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Frederick, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.