Healthcare Provider Details

I. General information

NPI: 1558326488
Provider Name (Legal Business Name): SATISH C VERMA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 HALLS CV
SENATOBIA MS
38668-6620
US

IV. Provider business mailing address

103 HALLS CV
SENATOBIA MS
38668-6620
US

V. Phone/Fax

Practice location:
  • Phone: 662-562-9003
  • Fax: 662-562-4007
Mailing address:
  • Phone: 662-562-9003
  • Fax: 662-562-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number14916
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: