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General NPI Number Information
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NPI Number | 1427360528
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Entity Type | Individual
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Provider Name | GANGADHARA NAGA RAGHAVENDRAN SEETHALA M.D
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Gender | Male
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 07/05/2012
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Provider Practice Location Address
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Address Line | 301 E 17TH ST
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City | NEW YORK
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State | NY
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Zip | 10003-3804
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Country | US
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Telephone | 212-598-6391
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Fax |
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Provider Business Mailing Address
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Address Line | 500 E 76TH ST APT # 3 RS,
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City | NEW YORK
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State | NY
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Zip | 10021-3160
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Country | US
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Telephone | 334-233-2537
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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