Individual
GOWTHAMI SAI KOGILATHOTA JAGIRDHAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
111 CENTRAL AVE, NEWARK, NJ 07102-1909
(973) 877-5000
Mailing address
111 CENTRAL AVE, NEWARK, NJ 07102-1909
(973) 877-5000
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/07/2020
Last updated
04/07/2020
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