Provider Demographics
NPI:1265497242
Name:DASS, SANJAY R (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:R
Last Name:DASS
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 1:16221 SAINT VINCENT WAY
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-9072
Mailing Address - Country:US
Mailing Address - Phone:501-552-8150
Mailing Address - Fax:501-552-8199
Practice Address - Street 1:16221 SAINT VINCENT WAY
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72223
Practice Address - Country:US
Practice Address - Phone:501-552-8150
Practice Address - Fax:501-552-8199
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4008207QG0300X
ARE4008207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR157860001Medicaid
AR157860001Medicaid
ARI34327OtherUPIN
ARP01266783OtherRAILROAD MCARE
ARP01266783OtherRAILROAD MCARE
ARP00385214OtherRAILROAD MEDICARE
AR157860001Medicaid
5N254Medicare PIN