Provider Demographics
NPI:1376635722
Name:SANGAVARAM, KRISTAPPA (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTAPPA
Middle Name:
Last Name:SANGAVARAM
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 1:303 MOLNAR DRIVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ELMWOOD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07407
Mailing Address - Country:US
Mailing Address - Phone:201-796-4007
Mailing Address - Fax:201-796-4080
Practice Address - Street 1:303 MOLNAR DRIVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ELMWOOD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07407
Practice Address - Country:US
Practice Address - Phone:201-796-4007
Practice Address - Fax:201-796-4080
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2017-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05589800207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology