Provider Demographics
NPI:1306986328
Name:SETHU V. MADHAVAN, MD INC
Entity type:Organization
Organization Name:SETHU V. MADHAVAN, MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETHU
Authorized Official - Middle Name:V
Authorized Official - Last Name:MADHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-945-7181
Mailing Address - Street 1:44215 15TH ST W STE 307
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-5505
Mailing Address - Country:US
Mailing Address - Phone:661-945-7181
Mailing Address - Fax:661-942-6008
Practice Address - Street 1:44215 15TH ST W STE 307
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-5505
Practice Address - Country:US
Practice Address - Phone:661-945-7181
Practice Address - Fax:661-942-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38104207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A381040Medicaid
CA00A381040Medicaid