Healthcare Provider Details

I. General information

NPI: 1467444752
Provider Name (Legal Business Name): BIPIN D SARODIA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 11/13/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

809 LAMONT ST DEPT 111B
JOHNSON CITY TN
37604-5453
US

IV. Provider business mailing address

809 LAMONT ST DEPT 111B
JOHNSON CITY TN
37604-5453
US

V. Phone/Fax

Practice location:
  • Phone: 937-321-5800
  • Fax:
Mailing address:
  • Phone: 937-321-5800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number2016-00009
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number2016-00009
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number57703
License Number StateTN
# 4
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number57703
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number2016-00009
License Number StateNC
# 6
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number57703
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: