Provider Demographics
NPI:1649410010
Name:MATH, JYOTI KIRAN (MD)
Entity type:Individual
Prefix:
First Name:JYOTI
Middle Name:KIRAN
Last Name:MATH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JYOTI
Other - Middle Name:B
Other - Last Name:SWAMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:21 BRENDAN WAY
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3514
Practice Address - Country:US
Practice Address - Phone:864-522-5030
Practice Address - Fax:864-522-5035
Is Sole Proprietor?:No
Enumeration Date:2009-02-25
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33054208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC330546Medicaid
SCP00951145OtherRAILROAD MEDICARE
SC330546Medicaid