Provider Demographics
NPI:1649249699
Name:EAPEN, SAJU SEBASTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:SAJU
Middle Name:SEBASTIAN
Last Name:EAPEN
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 1:1505 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24016-5206
Mailing Address - Country:US
Mailing Address - Phone:540-343-7331
Mailing Address - Fax:540-343-7349
Practice Address - Street 1:1505 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24016-5206
Practice Address - Country:US
Practice Address - Phone:540-343-7331
Practice Address - Fax:540-343-7349
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231964207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7604084Medicaid
VAH19046Medicare UPIN