Provider Demographics
NPI:1538137971
Name:PURI, SAJEEV K (MD)
Entity Type:Individual
Prefix:DR
First Name:SAJEEV
Middle Name:K
Last Name:PURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6035 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28210-3256
Mailing Address - Country:US
Mailing Address - Phone:704-295-3000
Mailing Address - Fax:704-295-3468
Practice Address - Street 1:6035 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3256
Practice Address - Country:US
Practice Address - Phone:704-295-3000
Practice Address - Fax:704-295-3468
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00997207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20084161OtherSELECT HEALTH OF SC
NC806719OtherPARTNERS
NC5902715Medicaid
NC3963046OtherAETNA
SC81904OtherCHC CARES OF SC
SCN0099AMedicaid
NC1400KOtherBCBS
NC326895OtherWELLPATH
NC1934975OtherCIGNA
NCE4696OtherMEDCOST
SC000000257099OtherUNISON HEALTH PLAN SC
I38601Medicare UPIN
2043498Medicare ID - Type Unspecified
NC1934975OtherCIGNA