Healthcare Provider Details

I. General information

NPI: 1124552328
Provider Name (Legal Business Name): SAGAR PRADEEP BAPAT M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9321 DISCOVERY WAY APT. F
LA JOLLA CA
92037-0096
US

IV. Provider business mailing address

9321 DISCOVERY WAY APT. F
LA JOLLA CA
92037-0096
US

V. Phone/Fax

Practice location:
  • Phone: 706-631-6230
  • Fax:
Mailing address:
  • Phone: 706-631-6230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: