Provider Demographics
NPI:1720023021
Name:KADEKAR, SITARAM G (MD)
Entity Type:Individual
Prefix:DR
First Name:SITARAM
Middle Name:G
Last Name:KADEKAR
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 1:15241 HEATHER MILL LN
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-6220
Mailing Address - Country:US
Mailing Address - Phone:571-261-9987
Mailing Address - Fax:
Practice Address - Street 1:2050 MEADOWVIEW PARKWAY
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7332
Practice Address - Country:US
Practice Address - Phone:423-230-5000
Practice Address - Fax:423-230-5097
Is Sole Proprietor?:No
Enumeration Date:2006-06-19
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39206174400000X, 207RC0000X, 207RI0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
No207RI0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical & Laboratory Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010150647Medicaid
TN621112685OtherUNITED HEALTHCARE
KY64110778Medicaid
TN00217007Medicaid
TN3327537Medicaid
TN3327537Medicaid
VA010150647Medicaid