Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 35779 | TN |
NPI | 1063465573 |
---|---|
Provider Name | Sangeetha Kodoth |
First Address | Knoxville, TN 37909-2453 |
Second Address | Knoxville, TN 37909-2453 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 06/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3873642 | (05) | TN |
H59798 | (02) | TN |