Provider Demographics
NPI:1013107903
Name:MAREPALLY, SAPNA R (MD)
Entity Type:Individual
Prefix:
First Name:SAPNA
Middle Name:R
Last Name:MAREPALLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 E SHEA BLVD
Mailing Address - Street 2:C-280
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-3071
Mailing Address - Country:US
Mailing Address - Phone:602-374-8030
Mailing Address - Fax:602-374-7728
Practice Address - Street 1:4626 E SHEA BLVD
Practice Address - Street 2:C-280
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-3071
Practice Address - Country:US
Practice Address - Phone:602-374-8030
Practice Address - Fax:602-374-7728
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ37273207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ248025Medicaid
AZ248025Medicaid
AZZ117622Medicare PIN