Provider Demographics
NPI:1508823998
Name:SAMPAT, PARAG (MD)
Entity Type:Individual
Prefix:
First Name:PARAG
Middle Name:
Last Name:SAMPAT
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 1:146 W DALE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1901
Mailing Address - Country:US
Mailing Address - Phone:319-234-4431
Mailing Address - Fax:319-235-5004
Practice Address - Street 1:146 W DALE ST
Practice Address - Street 2:SUITE 201
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1901
Practice Address - Country:US
Practice Address - Phone:319-234-4431
Practice Address - Fax:319-235-5004
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-37542207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1508823998Medicaid
IL036111150Medicaid
ILI46297Medicare UPIN
IA71926041Medicare PIN
IA71926041Medicare PIN