Healthcare Provider Details

I. General information

NPI: 1164005344
Provider Name (Legal Business Name): SAURABH SUBHASH KATARIA MD, MHA, MSITM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 12TH AVE NW STE 302
ARDMORE OK
73401-5765
US

IV. Provider business mailing address

731 12TH AVE NW STE 302
ARDMORE OK
73401-5765
US

V. Phone/Fax

Practice location:
  • Phone: 580-220-6200
  • Fax: 580-220-6258
Mailing address:
  • Phone: 580-220-6200
  • Fax: 580-220-6258

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number47169
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD2025-0457
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number47169
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number47169
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: