MEDICARE: DR. RENU JERATH SETH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	153068-2	NY
2	207Q00000X	Family Medicine Physician	153068-2	NY
3	207R00000X	Internal Medicine Physician	153068-2	NY

General Provider Information

NPI Number	:	1568446789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RENU JERATH SETH MD

Provider Business Mailing Address
First Line	:	104 ADAIR DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530-4516
Country	:	US
Telephone Number	:	845-901-6223
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 ADAIR DR
Second Line	:
City	:	GOLDSBORO
State	:	NC
Zip	:	27530-4516
Country	:	US
Telephone Number	:	845-901-6223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2005
Last Update Date	:	03/24/2015

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