1033193933 NPI number — DR. VIJAYA G SESHADRI MD, FAAP, FACC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033193933 NPI number — DR. VIJAYA G SESHADRI MD, FAAP, FACC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SESHADRI
Provider First Name:
VIJAYA
Provider Middle Name:
G
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, FAAP, FACC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033193933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4002 PIN OAK CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURRYSVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15668-9799
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-387-1255
Provider Business Mailing Address Fax Number:
724-325-6325

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4262 OLD WILLIAM PENN HWY STE 208
Provider Second Line Business Practice Location Address:
MURRYSVILLE COMMONS
Provider Business Practice Location Address City Name:
MURRYSVILLE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15668-1954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-387-1255
Provider Business Practice Location Address Fax Number:
724-325-6325
Provider Enumeration Date:
12/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  MD049597L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X , with the licence number: MD049597L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001047830-0011 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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