Healthcare Provider Details

I. General information

NPI: 1306305362
Provider Name (Legal Business Name): NILESH SESHADRI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 06/22/2022
Certification Date: 06/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC PULMONOLOGY
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

3401 CIVIC CENTER BLVD DIVISION OF PEDIATRIC PULMONOLOGY
PHILADELPHIA PA
19104
US

V. Phone/Fax

Practice location:
  • Phone: 267-475-3660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0214X
TaxonomyPediatric Pulmonology Physician
License NumberMT224929
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: