Provider Demographics
NPI:1912954009
Name:POLEPALLE, SAPAN K (MD)
Entity Type:Individual
Prefix:
First Name:SAPAN
Middle Name:K
Last Name:POLEPALLE
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:PO BOX 2157
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10949-7157
Mailing Address - Country:US
Mailing Address - Phone:845-346-5815
Mailing Address - Fax:718-684-2518
Practice Address - Street 1:2940 GRAND CONCOURSE
Practice Address - Street 2:SUITE 1A
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-2611
Practice Address - Country:US
Practice Address - Phone:718-684-2516
Practice Address - Fax:718-684-2518
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239371208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02753693Medicaid
NY4S4911Medicare ID - Type Unspecified
NY02753693Medicaid