Provider Demographics
NPI:1073951232
Name:SENGOTTUVELU, SABAPATHY R (MD)
Entity Type:Individual
Prefix:DR
First Name:SABAPATHY
Middle Name:R
Last Name:SENGOTTUVELU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13824 RUSSELL ZEPP DR
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1442
Mailing Address - Country:US
Mailing Address - Phone:301-854-1575
Mailing Address - Fax:301-854-1546
Practice Address - Street 1:13824 RUSSELL ZEPP DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1442
Practice Address - Country:US
Practice Address - Phone:301-854-1575
Practice Address - Fax:301-854-1546
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAU4176435A2249172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker