Provider Demographics
NPI:1063651123
Name:KALISETTI, DEEPIKA RAO (MD)
Entity Type:Individual
Prefix:
First Name:DEEPIKA
Middle Name:RAO
Last Name:KALISETTI
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Gender:F
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:743 JEFFERSON AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1639
Mailing Address - Country:US
Mailing Address - Phone:570-342-1776
Mailing Address - Fax:570-207-1910
Practice Address - Street 1:743 JEFFERSON AVE STE 305
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1639
Practice Address - Country:US
Practice Address - Phone:570-342-1776
Practice Address - Fax:570-207-1910
Is Sole Proprietor?:No
Enumeration Date:2009-02-13
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD445170207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology