Provider Demographics
NPI:1194936930
Name:MISHRA, SEEMA LYNN (MD)
Entity type:Individual
Prefix:
First Name:SEEMA
Middle Name:LYNN
Last Name:MISHRA
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 1:8116 GRISWOLD DR
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8169
Mailing Address - Country:US
Mailing Address - Phone:614-775-1522
Mailing Address - Fax:
Practice Address - Street 1:3099 W STATE ROUTE 113
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-9606
Practice Address - Country:US
Practice Address - Phone:419-663-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH68333207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G56630Medicare UPIN