MEDICARE: DR. SULABHA R. DANGE MD

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	207R00000X	Internal Medicine Physician	35068713	OH

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	:	1598743296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SULABHA R. DANGE MD

Provider Business Mailing Address
First Line	:	74 N BREIEL BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45042-3804
Country	:	US
Telephone Number	:	513-424-7291
Fax Number	:	937-223-9811

Provider Business Practice Location Address
First Line	:	74 N BREIEL BLVD
Second Line	:
City	:	MIDDLETOWN
State	:	OH
Zip	:	45042-3804
Country	:	US
Telephone Number	:	513-424-7291
Fax Number	:	937-223-9811

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	03/10/2017

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