Healthcare Provider Details

I. General information

NPI: 1700185089
Provider Name (Legal Business Name): SANJAYA KUMAR SATAPATHY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 UNION AVE SUITE 640
MEMPHIS TN
38104-3627
US

IV. Provider business mailing address

1407 UNION AVE SUITE 640
MEMPHIS TN
38104-3627
US

V. Phone/Fax

Practice location:
  • Phone: 901-866-8813
  • Fax: 901-302-2120
Mailing address:
  • Phone: 901-866-8372
  • Fax: 901-302-2372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD0000047432
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberMD0000047432
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207RT0003X
TaxonomyTransplant Hepatology Physician
License NumberMD0000047432
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: