Provider Demographics
NPI:1043237837
Name:SATAPATHY, GOVINDA CHANDRA (MD)
Entity type:Individual
Prefix:
First Name:GOVINDA
Middle Name:CHANDRA
Last Name:SATAPATHY
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 1:8753 W IRMA LN
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-6440
Mailing Address - Country:US
Mailing Address - Phone:623-849-1988
Mailing Address - Fax:623-849-1981
Practice Address - Street 1:9305 W THOMAS RD
Practice Address - Street 2:#285
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85037-3328
Practice Address - Country:US
Practice Address - Phone:623-849-1988
Practice Address - Fax:623-849-1981
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ24551207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ371203Medicaid
AZG42972Medicare UPIN
AZ371203Medicaid