Provider Demographics
NPI:1770534497
Name:MAVI, SANTPAL S (MD)
Entity type:Individual
Prefix:
First Name:SANTPAL
Middle Name:S
Last Name:MAVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5002
Mailing Address - Fax:740-446-5883
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5002
Practice Address - Fax:740-446-5883
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV18878207RP1001X
OH35-07-6701207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000185258OtherUNISON MEDICAID
001714113OtherMOUNTAIN STATE BCBS
OH310917085095OtherCARESOURCE MEDICAID
OH2069041OtherMOLINA MEDICAID
WV0081705000Medicaid
290011997OtherRR MEDICARE
000000198558OtherANTHEM BCBS
000000198558OtherANTHEM BCBS
G78383Medicare UPIN
WV0081705000Medicaid
WV0857073Medicare PIN