1144332495 NPI number — SUDARSHAN R DODDABELE MD

Table of content: SUDARSHAN R DODDABELE MD (NPI 1144332495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144332495 NPI number — SUDARSHAN R DODDABELE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DODDABELE
Provider First Name:
SUDARSHAN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144332495
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 E HILL AVE STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37915-2565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-862-0998
Provider Business Mailing Address Fax Number:
865-544-1861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1415 OLD WEISGARBER RD STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37909-1341
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-934-5800
Provider Business Practice Location Address Fax Number:
865-934-5801
Provider Enumeration Date:
08/31/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  48401 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 31484 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)