Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 25MA0543770 | NJ |
NPI | 1316916166 |
---|---|
Provider Name | Seshadri Shekar Chakravarthi |
First Address | Flemington, NJ 08822-4603 |
Second Address | Flemington, NJ 08822-4603 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/03/2006 |
Last Update Date | 25/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7931204 | (05) | NJ |
E96139 | (02) | NJ |