Healthcare Provider Details

I. General information

NPI: 1033514369
Provider Name (Legal Business Name): SWATHI SETHURAM MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 BROADWAY BLDG 12
OAKLAND CA
94611-5798
US

IV. Provider business mailing address

45060 SYNERGY ST APT 262
FREMONT CA
94538-6246
US

V. Phone/Fax

Practice location:
  • Phone: 510-963-2146
  • Fax:
Mailing address:
  • Phone: 347-951-6246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number25MA10831300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberC206279
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number289700
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: