Basic Information
Provider Information
NPI: 1396163168
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: NARAYANAN
FirstName: JENESHA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 110 IRVING ST NW STE 2A38M
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200103017
CountryCode: US
TelephoneNumber: 2028774677
FaxNumber: 2028777973
Practice Location
Address1: 110 IRVING ST NW
Address2: DEPT OF INTERNAL MEDICINE
City: WASHINGTON
State: DC
PostalCode: 200103017
CountryCode: US
TelephoneNumber: 2028772835
FaxNumber: 2028776292
Other Information
ProviderEnumerationDate: 03/31/2014
LastUpdateDate: 09/19/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XMD045480DCY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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