Provider Demographics
NPI:1174579726
Name:JAWANDA, JASPAUL S (MD)
Entity type:Individual
Prefix:
First Name:JASPAUL
Middle Name:S
Last Name:JAWANDA
Suffix:
Gender:M
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 843026
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-3026
Mailing Address - Country:US
Mailing Address - Phone:910-715-5481
Mailing Address - Fax:910-715-5745
Practice Address - Street 1:35 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:PINEHURST
Practice Address - State:NC
Practice Address - Zip Code:28374-8708
Practice Address - Country:US
Practice Address - Phone:910-715-5481
Practice Address - Fax:910-715-5745
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC200201265207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
H66638Medicare UPIN
NC2030087BMedicare ID - Type Unspecified