Provider Demographics
NPI:1508813346
Name:SEGARAM, SANDIRA V (MD, FACP)
Entity Type:Individual
Prefix:DR
First Name:SANDIRA
Middle Name:V
Last Name:SEGARAM
Suffix:
Gender:M
Credentials:MD, FACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:653 WILLOW GROVE ST
Mailing Address - Street 2:SUITE 1600
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-1732
Mailing Address - Country:US
Mailing Address - Phone:908-813-2888
Mailing Address - Fax:908-813-2521
Practice Address - Street 1:653 WILLOW GROVE ST
Practice Address - Street 2:SUITE 1600
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-1732
Practice Address - Country:US
Practice Address - Phone:908-813-2888
Practice Address - Fax:908-813-2521
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-27
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA05040500207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine