Provider Demographics
NPI:1578697090
Name:KACHIRAYAN, VASANTHI (MD,)
Entity Type:Individual
Prefix:DR
First Name:VASANTHI
Middle Name:
Last Name:KACHIRAYAN
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 1:68 ALDER LN
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-3708
Mailing Address - Country:US
Mailing Address - Phone:908-532-0950
Mailing Address - Fax:
Practice Address - Street 1:3322 US HIGHWAY 22
Practice Address - Street 2:SUITE 806
Practice Address - City:BRANCHBURG
Practice Address - State:NJ
Practice Address - Zip Code:08876-3476
Practice Address - Country:US
Practice Address - Phone:908-231-9900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA73372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8776504Medicaid
NJH58029Medicare UPIN
NJ8776504Medicaid