Healthcare Provider Details

I. General information

NPI: 1396887352
Provider Name (Legal Business Name): MEERA SACHDEVA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 08/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 ASTON AVE # 200
MCCOMB MS
39648-2734
US

IV. Provider business mailing address

PO BOX 1963
MCCOMB MS
39649-1963
US

V. Phone/Fax

Practice location:
  • Phone: 601-249-5526
  • Fax:
Mailing address:
  • Phone: 601-981-5887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number18057
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: