Individual
DR. KAVITA S BOMMASAMUDRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8 CHURCH ST, WILKES BARRE, PA 18702-3542
(570) 808-3700
Mailing address
655 E. LIVINGSTON ST., ELIZABETH, NJ 07206
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD471297
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/23/2018
Last updated
11/01/2021
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