Basic Information
Provider Information
NPI: 1003804204
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: EAPEN
FirstName: SAJI
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName: EAPEN
OtherFirstName: SAJI
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
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
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RH0003XMD41548TNY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

ID Information
IDTypeStateIssuerDescription
210140401 UNITED HEALTHCAREOTHER
01008142405VA MEDICAID
6196000201 BCBS CAREFIRSTOTHER
01008141605VA MEDICAID
28252901 AMERIGROUPOTHER
360765401 AETNA HMOOTHER
701361301 AETNA PPOOTHER
68323701 NCPPOOTHER
312899801 MAMSI OPT CHOICEOTHER


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