Provider Demographics
NPI:1851383798
Name:AYYAGARI, KALAVATHI (MD)
Entity Type:Individual
Prefix:DR
First Name:KALAVATHI
Middle Name:
Last Name:AYYAGARI
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 1:2010 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07040-3437
Mailing Address - Country:US
Mailing Address - Phone:973-761-8500
Mailing Address - Fax:973-761-8910
Practice Address - Street 1:2010 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07040-3437
Practice Address - Country:US
Practice Address - Phone:973-761-8500
Practice Address - Fax:973-761-8910
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA30677174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0849901Medicaid
NJ0849901Medicaid
NJD06459Medicare UPIN