Basic Information
| Provider Information | |||||||||
| NPI: | 1003804204 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EAPEN | ||||||||
| FirstName: | SAJI | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | EAPEN | ||||||||
| OtherFirstName: | SAJI | ||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 900 E HILL AVE | ||||||||
| Address2: | SUITE 230 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379152566 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8658620998 | ||||||||
| FaxNumber: | 8655441861 | ||||||||
| Practice Location | |||||||||
| Address1: | 1415 OLD WEISGARBER RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379091327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659345800 | ||||||||
| FaxNumber: | 8659345801 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2005 | ||||||||
| LastUpdateDate: | 09/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | MD41548 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2101404 | 01 | UNITED HEALTHCARE | OTHER | 010081424 | 05 | VA | MEDICAID | 683237 | 01 | NCPPO | OTHER | 7013613 | 01 | AETNA PPO | OTHER | 282529 | 01 | AMERIGROUP | OTHER | 61960002 | 01 | BCBS CAREFIRST | OTHER | 3128998 | 01 | MAMSI OPT CHOICE | OTHER | 010081416 | 05 | VA | MEDICAID | 3607654 | 01 | AETNA HMO | OTHER |