Provider Demographics
NPI:1770504656
Name:JETTY, SATHISH V (MD)
Entity Type:Individual
Prefix:
First Name:SATHISH
Middle Name:V
Last Name:JETTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:272 HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:CHILLICOTHE
Mailing Address - State:OH
Mailing Address - Zip Code:45601-9031
Mailing Address - Country:US
Mailing Address - Phone:740-779-7795
Mailing Address - Fax:740-779-4257
Practice Address - Street 1:4439 STATE ROUTE 159
Practice Address - Street 2:STE G10
Practice Address - City:CHILLICOTHE
Practice Address - State:OH
Practice Address - Zip Code:45601-8207
Practice Address - Country:US
Practice Address - Phone:740-779-4300
Practice Address - Fax:740-779-4390
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.064617208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0952625Medicaid