Provider Demographics
NPI:1194732230
Name:MADHAVAN, SETHU V (MD)
Entity type:Individual
Prefix:DR
First Name:SETHU
Middle Name:V
Last Name:MADHAVAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9421 OAK LEAF DR
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-4700
Mailing Address - Country:US
Mailing Address - Phone:661-945-7181
Mailing Address - Fax:661-942-6008
Practice Address - Street 1:867 W LANCASTER BLVD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2348
Practice Address - Country:US
Practice Address - Phone:661-945-7181
Practice Address - Fax:661-942-6008
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA38104207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A381040Medicaid
CA00A381040Medicaid