Provider Demographics
NPI:1023100815
Name:NESARGI, SUSMITA B (MD)
Entity type:Individual
Prefix:DR
First Name:SUSMITA
Middle Name:B
Last Name:NESARGI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:NEMOURS CHILDRENS CLINIC
Mailing Address - Street 2:P.O. BOX 404112
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-0001
Mailing Address - Country:US
Mailing Address - Phone:904-390-3610
Mailing Address - Fax:904-288-5890
Practice Address - Street 1:A.I. DUPONT HOSPITAL FOR CHILDREN
Practice Address - Street 2:1600 ROCKLAND ROAD
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-3607
Practice Address - Country:US
Practice Address - Phone:302-651-4000
Practice Address - Fax:302-651-4945
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEC10007321207L00000X, 207LP3000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101105860Medicaid
MD4058259Medicaid
NY0265061Medicaid
MN065412000Medicaid
NJ0044466Medicaid
IA0596973Medicaid
NJ0044466Medicaid
PA101105860Medicaid