Provider Demographics
NPI:1386964468
Name:SAMPATH, RAHUL (MD)
Entity type:Individual
Prefix:DR
First Name:RAHUL
Middle Name:
Last Name:SAMPATH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 FOOTHILLS DR STE B
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5123
Mailing Address - Country:US
Mailing Address - Phone:828-580-5705
Mailing Address - Fax:828-580-8033
Practice Address - Street 1:111 FOOTHILLS DR STE B
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5123
Practice Address - Country:US
Practice Address - Phone:828-580-5705
Practice Address - Fax:828-580-8033
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10038074207R00000X
MN57073207RI0200X
MN106885207RI0200X
NC2015-02323207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1386964468Medicaid