Provider Demographics
NPI:1457399156
Name:LINGINENI, KAVITHA (MD)
Entity Type:Individual
Prefix:
First Name:KAVITHA
Middle Name:
Last Name:LINGINENI
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 1:10 MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-1318
Mailing Address - Country:US
Mailing Address - Phone:732-309-5655
Mailing Address - Fax:
Practice Address - Street 1:1400 BLACK HORSE HILL ROAD
Practice Address - Street 2:VETERANS AFFAIRS MEDICAL CENTER
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-2096
Practice Address - Country:US
Practice Address - Phone:610-384-7711
Practice Address - Fax:610-380-4345
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA71923207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ9083006Medicaid
NJH68052Medicare UPIN
NJ060551Medicare ID - Type Unspecified