MEDICARE: SARATH B GANGAVARAPU MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	MD0000016350	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427071380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SARATH B GANGAVARAPU MD PC

Provider Business Mailing Address
First Line	:	PO BOX 4816
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37320
Country	:	US
Telephone Number	:	423-559-8989
Fax Number	:	423-559-8984

Provider Business Practice Location Address
First Line	:	2765 EXECUTIVE PARK DR NW
Second Line	:	STE 1
City	:	CLEVELAND
State	:	TN
Zip	:	37312
Country	:	US
Telephone Number	:	423-559-8989
Fax Number	:	423-559-8984

Authorized Official
Title or Position	:	MEDICAL
Name	:	SARATH B GANGAVARAPU
Credential	:	MD
Telephone Number	:	423-559-8989

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	08/22/2020

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