Healthcare Provider Details

I. General information

NPI: 1851658777
Provider Name (Legal Business Name): KAVITHA SELVARAJ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

471 BARNUM AVE
BRIDGEPORT CT
06608-2409
US

IV. Provider business mailing address

96 CLINTON AVE # 243
NEWARK NJ
07114-2012
US

V. Phone/Fax

Practice location:
  • Phone: 203-333-3030
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number86291
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code2080B0002X
TaxonomyPediatric Obesity Medicine Physician
License Number86291
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: