Active NPI
Lalita Seetharam, MD
- Gynecology Physician
- Fayetteville, NY
National Provider Identifier
1396706495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Gynecology Physician
- License
- 115936
- Practice address
- 4117 Medical Center Dr
Fayetteville, NY 13066-6600 - Phone
- (315) 329-4968
- Fax
- (315) 329-4964
- NPI assigned
- Mar 29, 2006
- Last updated
- Nov 23, 2011
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gynecology Physician | 207VG0400X | 115936 | NY | Primary |
Addresses
Primary practice location
4117 Medical Center Dr
Fayetteville, NY 13066-6600
Mailing address
4117 Medical Center Dr
Pod a
Fayetteville, NY 13066-6600
Phone (315) 329-4968
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00466564 | Medicaid | NY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115936 | NY | MD | Gynecology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143590400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1322006400000",
"number": "1396706495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4117 MEDICAL CENTER DR",
"address_2": "POD A",
"city": "FAYETTEVILLE",
"state": "NY",
"postal_code": "130666600",
"telephone_number": "315-329-4968",
"fax_number": "315-329-4964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4117 MEDICAL CENTER DR",
"city": "FAYETTEVILLE",
"state": "NY",
"postal_code": "130666600",
"telephone_number": "315-329-4968",
"fax_number": "315-329-4964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEETHARAM",
"first_name": "LALITA",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-03-29",
"last_updated": "2011-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "207VG0400X",
"taxonomy_group": "",
"desc": "Obstetrics & Gynecology, Gynecology",
"state": "NY",
"license": "115936",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00466564",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.