Provider Demographics
NPI:1881630028
Name:GOURKANTI, SEETERAM RAO (MD)
Entity Type:Individual
Prefix:DR
First Name:SEETERAM
Middle Name:RAO
Last Name:GOURKANTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 SEVEN BRIDGES RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE SILVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07739-1634
Mailing Address - Country:US
Mailing Address - Phone:732-741-4668
Mailing Address - Fax:732-219-1681
Practice Address - Street 1:31 SEVEN BRIDGES RD
Practice Address - Street 2:
Practice Address - City:LITTLE SILVER
Practice Address - State:NJ
Practice Address - Zip Code:07739-1634
Practice Address - Country:US
Practice Address - Phone:732-741-4668
Practice Address - Fax:732-219-1681
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05530300207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4620305Medicaid
NJ68135Medicare ID - Type Unspecified
NJ4620305Medicaid