Provider Demographics
NPI:1477574531
Name:GARG, GEETANJALI DAVULURI (MD)
Entity Type:Individual
Prefix:DR
First Name:GEETANJALI
Middle Name:DAVULURI
Last Name:GARG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 CHAMBERS ST
Mailing Address - Street 2:#2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-1836
Mailing Address - Country:US
Mailing Address - Phone:212-580-1730
Mailing Address - Fax:
Practice Address - Street 1:98 CHAMBERS ST
Practice Address - Street 2:#2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10007-1836
Practice Address - Country:US
Practice Address - Phone:212-580-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0064904207W00000X
VA0101240063207W00000X
DCMD035552207W00000X
NY2633741207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411639900Medicaid
863LP013Medicare PIN
011675B26Medicare PIN
020288B51Medicare PIN
MD411639900Medicaid