Provider Demographics
NPI:1679778062
Name:SYAMALA, JIJI (MD)
Entity type:Individual
Prefix:
First Name:JIJI
Middle Name:
Last Name:SYAMALA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-0001
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8235
Practice Address - Street 1:4900 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2618
Practice Address - Country:US
Practice Address - Phone:215-831-2000
Practice Address - Fax:215-807-8235
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD432320208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1747437OtherAETNA
PA38876OtherHEALTH PARTNERS
PA102168440001Medicaid
PA2865242000OtherKEYSTONE IBC
PA2865242000OtherPERSONAL CHOICE
PA1990096OtherHIGHMARK BLUE SHIELD
PA1679778062OtherNPI #