Provider Demographics
NPI:1073506606
Name:NAGESETTY, GIRISH BABU (MD)
Entity Type:Individual
Prefix:
First Name:GIRISH
Middle Name:BABU
Last Name:NAGESETTY
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 1:1251 NILLES ROAD
Mailing Address - Street 2:SUITE17
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-7205
Mailing Address - Country:US
Mailing Address - Phone:513-829-7133
Mailing Address - Fax:513-829-7134
Practice Address - Street 1:1251 NILLES ROAD
Practice Address - Street 2:SUITE17
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-7205
Practice Address - Country:US
Practice Address - Phone:513-829-7133
Practice Address - Fax:513-829-7134
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-04-7185208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0489734Medicaid
IN100007840OtherINDIANA MEDICAID
IN100007840OtherINDIANA MEDICAID
A15137Medicare UPIN
OHH287240Medicare PIN