Provider Demographics
NPI:1477843217
Name:SANGHVI, KATIE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:SANGHVI
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 1:185 SOUTH ORANGE AVE., MSB E-609
Mailing Address - Street 2:RUTGERS DEPARTMENT OF EMERGENCY MEDICINE
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07103
Mailing Address - Country:US
Mailing Address - Phone:973-972-9261
Mailing Address - Fax:
Practice Address - Street 1:150 BERGEN ST.
Practice Address - Street 2:THE UNIVERSITY HOSPITAL
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07103
Practice Address - Country:US
Practice Address - Phone:973-972-4300
Practice Address - Fax:513-831-5985
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.120869208D00000X
390200000X
NJ25MA09930800207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program