Provider Demographics
NPI:1366675035
Name:THIMMAPURAM, JAYARAM REDDY (MD,)
Entity type:Individual
Prefix:DR
First Name:JAYARAM
Middle Name:REDDY
Last Name:THIMMAPURAM
Suffix:
Gender:M
Credentials:MD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-2231
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-6969
Practice Address - Street 1:25 MONUMENT RD
Practice Address - Street 2:SUITE 140
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-5060
Practice Address - Country:US
Practice Address - Phone:717-741-8003
Practice Address - Fax:717-461-7404
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446140207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA30136824OtherAMERIHEALTH MERCY-WMG
PA1613259OtherGATEWAY
PA2730561OtherHIGHMARK BLUE SHIELD
PA30153625OtherAMERIHEALTH CARITAS PA - WMG - AHIM
PA102759492Medicaid
PA418988OtherUPMC
PA256556FLTMedicare PIN
PA30136824OtherAMERIHEALTH MERCY-WMG