Provider Demographics
NPI:1417930496
Name:SANCHETI, SURAJ P (MD)
Entity Type:Individual
Prefix:DR
First Name:SURAJ
Middle Name:P
Last Name:SANCHETI
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 1:3226 RAINBOW DR
Mailing Address - Street 2:
Mailing Address - City:RAINBOW CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35906-5805
Mailing Address - Country:US
Mailing Address - Phone:256-442-8380
Mailing Address - Fax:256-442-8312
Practice Address - Street 1:3226 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-5805
Practice Address - Country:US
Practice Address - Phone:256-442-8380
Practice Address - Fax:256-442-8312
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-23
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7811207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000045475OtherBLUE CROSS BLUE SHIELD
AL000045475OtherBLUE CROSS BLUE SHIELD