Basic Information
| Provider Information | |||||||||
| NPI: | 1457399156 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LINGINENI | ||||||||
| FirstName: | KAVITHA | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10 MAPLE AVE | ||||||||
| Address2: | |||||||||
| City: | METUCHEN | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 088401318 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323095655 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1400 BLACK HORSE HILL ROAD | ||||||||
| Address2: | VETERANS AFFAIRS MEDICAL CENTER | ||||||||
| City: | COATESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193202096 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103847711 | ||||||||
| FaxNumber: | 6103804345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MA71923 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 9083006 | 05 | NJ | MEDICAID |