Provider Demographics
NPI:1700801537
Name:KAMATH, SANJAY V (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:V
Last Name:KAMATH
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:P.O. BOX 6578
Mailing Address - Street 2:
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96931-6578
Mailing Address - Country:US
Mailing Address - Phone:671-646-6956
Mailing Address - Fax:671-647-3546
Practice Address - Street 1:548 SOUTH MARINE CORPS DRIVE
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913
Practice Address - Country:US
Practice Address - Phone:671-646-5824
Practice Address - Fax:671-647-3546
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT433012085R0202X
DECI00079462085R0202X
GA0565772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3192598Medicaid
G90407Medicare UPIN