Provider Demographics
NPI:1821046020
Name:TRIPATHY, SANCHAYITA (MD)
Entity Type:Individual
Prefix:DR
First Name:SANCHAYITA
Middle Name:
Last Name:TRIPATHY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ITA
Other - Middle Name:
Other - Last Name:TRIPATHY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:509 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3302
Mailing Address - Country:US
Mailing Address - Phone:573-368-7000
Mailing Address - Fax:574-364-6570
Practice Address - Street 1:509 E 10TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3302
Practice Address - Country:US
Practice Address - Phone:573-368-7000
Practice Address - Fax:574-364-6570
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO107174207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207613001Medicaid
MO000004944Medicare ID - Type Unspecified
MO207613001Medicaid
MO0220002OtherUNITED HEALTHCARE
MO266270OtherHEALTHLINK
MO000004944Medicare ID - Type Unspecified
MO286203OtherGROUP HEALTH PLAN
MO5676838OtherFIRST HEALTH