Provider Demographics
NPI:1932170438
Name:SAI UROLOGY PA
Entity Type:Organization
Organization Name:SAI UROLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:NATARAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAJAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-308-6889
Mailing Address - Street 1:117 PROFESSIONAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE RAPIDS
Mailing Address - State:NC
Mailing Address - Zip Code:27870-3220
Mailing Address - Country:US
Mailing Address - Phone:252-308-6889
Mailing Address - Fax:252-308-0049
Practice Address - Street 1:117 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:ROANOKE RAPIDS
Practice Address - State:NC
Practice Address - Zip Code:27870-3220
Practice Address - Country:US
Practice Address - Phone:252-308-6889
Practice Address - Fax:252-308-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2011-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9800672208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0112NOtherBCBS
NC340017191OtherRAILROAD MEDICARE
NC790112NMedicaid
NC790112NMedicaid
NC0112NOtherBCBS