NPIMap

Organization Active NPI

Supriya Jagannath MD LLC

  • Anesthesiology Physician
  • Salisbury, MD
National Provider Identifier
1184899403
Registry record updated Apr 28, 2008
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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
100 E Carroll St
Salisbury, MD 21801-5422
Phone
(410) 543-7530
NPI assigned
Apr 28, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2008

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

Authorized official

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

Specialties & licenses 1

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

Addresses

Primary practice location

100 E Carroll St
Salisbury, MD 21801-5422

Mailing address

PO Box 2181
Salisbury, MD 21802-2181
Phone (410) 476-7511

Other identifiers 1

IdentifierTypeStateIssuer
411276800MedicaidMD

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1209340800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209340800000",
    "number": "1184899403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2181",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218022181",
            "telephone_number": "410-476-7511"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 E CARROLL ST",
            "city": "SALISBURY",
            "state": "MD",
            "postal_code": "218015422",
            "telephone_number": "410-543-7530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPRIYA JAGANNATH MD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-28",
        "last_updated": "2008-04-28",
        "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": "M.D."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology",
            "state": "MD",
            "license": "D0064112",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "411276800",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salisbury, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2008; 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.