Provider Demographics
NPI:1265486252
Name:MOVVA, SASHIDHAR SESHUKUMAR (MD)
Entity Type:Individual
Prefix:
First Name:SASHIDHAR
Middle Name:SESHUKUMAR
Last Name:MOVVA
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 1:7237 HANOVER PKWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3602
Mailing Address - Country:US
Mailing Address - Phone:301-345-3232
Mailing Address - Fax:301-345-5947
Practice Address - Street 1:7237 HANOVER PKWY
Practice Address - Street 2:SUITE A
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-3602
Practice Address - Country:US
Practice Address - Phone:301-345-3232
Practice Address - Fax:301-345-5947
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-22
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD39600204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD082591300Medicaid
670964Medicare ID - Type Unspecified
MD082591300Medicaid