Provider Demographics
NPI:1063426930
Name:KESARI, PARVATHI S (MD)
Entity type:Individual
Prefix:
First Name:PARVATHI
Middle Name:S
Last Name:KESARI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1250
Mailing Address - Street 2:99 EAST STATE STREET
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078
Mailing Address - Country:US
Mailing Address - Phone:518-773-5690
Mailing Address - Fax:518-773-5620
Practice Address - Street 1:99 E STATE ST
Practice Address - Street 2:MAB-GPCC
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1203
Practice Address - Country:US
Practice Address - Phone:518-773-5690
Practice Address - Fax:518-773-5620
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-01-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY215524207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02089196Medicaid
NYH14049Medicare UPIN
NY02089196Medicaid