Healthcare Provider Details

I. General information

NPI: 1386786168
Provider Name (Legal Business Name): SESHAGIRI RAO MEKA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HOPE AVE SUITE 107
WALTHAM MA
02453-2721
US

IV. Provider business mailing address

24 BRISTOL RD
PEABODY MA
01960-3474
US

V. Phone/Fax

Practice location:
  • Phone: 781-894-5522
  • Fax:
Mailing address:
  • Phone: 781-894-5522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number41809
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: