Provider Demographics
NPI:1194073106
Name:KESAVAN, PAVITHRA (MD)
Entity type:Individual
Prefix:DR
First Name:PAVITHRA
Middle Name:
Last Name:KESAVAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16251 SYLVESTER RD SW
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3017
Mailing Address - Country:US
Mailing Address - Phone:253-426-6341
Mailing Address - Fax:360-698-7002
Practice Address - Street 1:16251 SYLVESTER RD SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3017
Practice Address - Country:US
Practice Address - Phone:253-426-6341
Practice Address - Fax:360-698-7002
Is Sole Proprietor?:No
Enumeration Date:2012-08-22
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60609851207R00000X
WAMD60609851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2061120Medicaid