Provider Demographics
NPI:1619104650
Name:PORUR EVALAPPAN, SATHESH (MD)
Entity Type:Individual
Prefix:DR
First Name:SATHESH
Middle Name:
Last Name:PORUR EVALAPPAN
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:PO BOX 5478
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08875-5478
Mailing Address - Country:US
Mailing Address - Phone:908-325-3060
Mailing Address - Fax:732-412-3123
Practice Address - Street 1:1553 STATE ROUTE 27 STE 2100
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-3995
Practice Address - Country:US
Practice Address - Phone:855-469-8744
Practice Address - Fax:908-333-4560
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAME100948208M00000X
NJ25MA08776700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0241539Medicaid
NJ191954YCGAMedicare PIN