Provider Demographics
NPI:1790971075
Name:DRS.S.V.MAGAVI & N.MAGAVI
Entity Type:Organization
Organization Name:DRS.S.V.MAGAVI & N.MAGAVI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KUSUMA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-744-7007
Mailing Address - Street 1:57 NORTH ST
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5660
Mailing Address - Country:US
Mailing Address - Phone:203-744-7007
Mailing Address - Fax:203-744-7049
Practice Address - Street 1:57 NORTH ST
Practice Address - Street 2:SUITE # 103
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-5660
Practice Address - Country:US
Practice Address - Phone:203-744-7007
Practice Address - Fax:203-744-7049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004164456Medicaid
CTC01356Medicare PIN