Healthcare Provider Details

I. General information

NPI: 1033193933
Provider Name (Legal Business Name): VIJAYA G SESHADRI MD, FAAP, FACC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2005
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4262 OLD WILLIAM PENN HWY STE 208 MURRYSVILLE COMMONS
MURRYSVILLE PA
15668-1954
US

IV. Provider business mailing address

4002 PIN OAK CT
MURRYSVILLE PA
15668-9799
US

V. Phone/Fax

Practice location:
  • Phone: 724-387-1255
  • Fax: 724-325-6325
Mailing address:
  • Phone: 724-387-1255
  • Fax: 724-325-6325

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD049597L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD049597L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: