Provider Demographics
NPI:1811168008
Name:SARI EAPEN
Entity type:Organization
Organization Name:SARI EAPEN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARI
Authorized Official - Middle Name:G
Authorized Official - Last Name:EAPEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-410-0001
Mailing Address - Street 1:257 HWY 125
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-6455
Mailing Address - Country:US
Mailing Address - Phone:252-410-0001
Mailing Address - Fax:252-410-0003
Practice Address - Street 1:257 HWY 125
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-6455
Practice Address - Country:US
Practice Address - Phone:252-410-0001
Practice Address - Fax:252-410-0003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC26226204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicare PIN