Provider Demographics
NPI:1982603353
Name:DUBAL, SAROJ B (MD)
Entity Type:Individual
Prefix:
First Name:SAROJ
Middle Name:B
Last Name:DUBAL
Suffix:
Gender:F
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 23955
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40523-3955
Mailing Address - Country:US
Mailing Address - Phone:859-271-3114
Mailing Address - Fax:859-271-0220
Practice Address - Street 1:101 PROSPEROUS PLACE
Practice Address - Street 2:SUITE 300
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1836
Practice Address - Country:US
Practice Address - Phone:859-271-3114
Practice Address - Fax:859-271-0220
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-19
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32292207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1168975OtherCHA HEALTH PIN
KY000000108103OtherANTHEM B/C PIN
KY2001268OtherUNITED HEALTHCARE PIN
KYC15401OtherBLUEGRASS FAMILY HEALTH
KY611369666OtherHUMANA PIN
KY64322928Medicaid
KYC15401OtherBLUEGRASS FAMILY HEALTH
KY64322928Medicaid