Individual
GEETHA JAGANNATHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MBBS
Contact information
Practice address
630 W 168TH ST, NEW YORK, NY 10032-3725
(212) 305-9217
Mailing address
6201 GREENLEIGH AVE FL 2, MIDDLE RIVER, MD 21220-2004
(410) 933-6421
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
311472
NY
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
D88568
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D88568
LICENSE
MD
Enumeration date
04/07/2016
Last updated
08/05/2021
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