Provider Demographics
NPI:1558551507
Name:AYYAPPAN, SABARISH R (MD)
Entity Type:Individual
Prefix:
First Name:SABARISH
Middle Name:R
Last Name:AYYAPPAN
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 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-7407
Mailing Address - Fax:319-353-8383
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242
Practice Address - Country:US
Practice Address - Phone:319-356-7407
Practice Address - Fax:319-353-8383
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-46041207R00000X, 207RH0000X
MA243101207R00000X, 208M00000X
OH35-097600207R00000X
OH35097600207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0051543Medicaid
OHPO1001831Medicare PIN
OHHO19870Medicare PIN