Provider Demographics
NPI:1215038435
Name:AMARAVADI, KAMESWARI (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KAMESWARI
Middle Name:
Last Name:AMARAVADI
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 186TH ST
Mailing Address - Street 2:
Mailing Address - City:FRESH MEADOWS
Mailing Address - State:NY
Mailing Address - Zip Code:11365-1610
Mailing Address - Country:US
Mailing Address - Phone:718-217-1930
Mailing Address - Fax:718-217-1846
Practice Address - Street 1:22217 BRADDOCK AVE
Practice Address - Street 2:
Practice Address - City:QUEENS VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11428-1409
Practice Address - Country:US
Practice Address - Phone:718-217-1930
Practice Address - Fax:718-217-1846
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY191527208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY244517OtherWELLCARE
NY55386OtherEMPIRE BLUE CROSS BLUE SH
NY100196194501OtherUNITED HEALTHCARE CHP
NY1201269OtherEMPIRE PLAN
NY2892OtherAFFINITY
NYAK1527OtherATLANTIS
NY2696045OtherGHI
NY54064NHOtherHIP
NY26P7911OtherNYPCHP
NY01623656Medicaid
NY191527-A27OtherHEALTHFIRST
NY2C0285OtherHEALTHNET
NYQN0057202OtherAMERICHOICE
NY576845OtherAETNA
NYP793594OtherOXFORD
NYAK1527OtherATLANTIS