Provider Demographics
NPI:1013964303
Name:VETTICHIRA, SAJEEV P (MD)
Entity Type:Individual
Prefix:DR
First Name:SAJEEV
Middle Name:P
Last Name:VETTICHIRA
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 1:147 HWY 24
Mailing Address - Street 2:HESTRON PLAZA, SUITE 102
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557-8998
Mailing Address - Country:US
Mailing Address - Phone:252-726-4000
Mailing Address - Fax:252-726-2530
Practice Address - Street 1:147 HWY 24
Practice Address - Street 2:HESTRON PLAZA, SUITE 102
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-8998
Practice Address - Country:US
Practice Address - Phone:252-726-4000
Practice Address - Fax:252-726-2530
Is Sole Proprietor?:No
Enumeration Date:2006-05-30
Last Update Date:2016-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2008-01449207RC0200X, 207RP1001X, 207RS0012X
FLME71430207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5910121OtherPTAN# 6472290001
NC5910121Medicaid
NC2022872Medicare PIN
NC5910121OtherPTAN# 6472290001
NC40811CMedicare PIN
FL01939XMedicare ID - Type Unspecified
F56001Medicare UPIN
NC5910121Medicaid