1417130337 NPI number — DEEPAK SARWAL, MD, LLC

Table of content: (NPI 1417130337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417130337 NPI number — DEEPAK SARWAL, MD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEEPAK SARWAL, MD, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1417130337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 186
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELLBROOK
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45305-0186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
937-291-0839
Provider Business Mailing Address Fax Number:
937-291-0854

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2205 MIAMISBURG CENTERVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45459-3816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
937-291-0839
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SARWAL
Authorized Official First Name:
DEEPAK
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
937-291-0839

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X , with the licence number:  35077166 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2937022 GROUP , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2141079 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com