Provider Demographics
NPI:1992769129
Name:NAIDU, SANJIV H (MD)
Entity type:Individual
Prefix:
First Name:SANJIV
Middle Name:H
Last Name:NAIDU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 TECHNOLOGY PKWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17050-9497
Mailing Address - Country:US
Mailing Address - Phone:717-791-2575
Mailing Address - Fax:717-791-2482
Practice Address - Street 1:2015 TECHNOLOGY PKWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-9497
Practice Address - Country:US
Practice Address - Phone:717-791-2575
Practice Address - Fax:717-791-2482
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2010-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD046434L207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0014734150001Medicaid
PA0014734150001Medicaid
F86318Medicare UPIN