Provider Demographics
NPI:1629145347
Name:MOPARTHY, SAMBASIVARAO R (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMBASIVARAO
Middle Name:R
Last Name:MOPARTHY
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 1:102 CANTERBURY RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2976
Mailing Address - Country:US
Mailing Address - Phone:478-272-5367
Mailing Address - Fax:
Practice Address - Street 1:102 CANTERBURY RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-2976
Practice Address - Country:US
Practice Address - Phone:478-272-5367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01029518A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine