Provider Demographics
NPI:1689094492
Name:GOMBAR, SAURABH
Entity Type:Individual
Prefix:
First Name:SAURABH
Middle Name:
Last Name:GOMBAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:
Practice Address - Street 1:12498 PEBBLE KNOLL WAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033-8238
Practice Address - Country:US
Practice Address - Phone:317-850-2234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-19
Last Update Date:2017-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA138842207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program