Provider Demographics
NPI:1134526189
Name:KATIKANENI, SWAPNA (MD)
Entity type:Individual
Prefix:
First Name:SWAPNA
Middle Name:
Last Name:KATIKANENI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SWAPNA
Other - Middle Name:
Other - Last Name:KATIKANENI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-920-2017
Mailing Address - Fax:718-920-5202
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-2017
Practice Address - Fax:718-920-5202
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09745500207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine