Provider Demographics
NPI:1144325341
Name:SAROCH, SANDEEP (MD)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:SAROCH
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 1:401 22ND ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7807
Mailing Address - Country:US
Mailing Address - Phone:606-329-0408
Mailing Address - Fax:606-329-0483
Practice Address - Street 1:401 22ND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7807
Practice Address - Country:US
Practice Address - Phone:606-329-0408
Practice Address - Fax:606-329-0483
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY364032084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64107626Medicaid
7029414OtherAETNA
WV3810007515Medicaid
067044OtherVALUE OPTIONS
OH2281936Medicaid
KY292325000OtherMAGELLAN
KY000000389590OtherBLUE CROSS & BLUE SHIELD
KYP00291904OtherRAILROAD MEDICARE
KYH38939Medicare UPIN
WV3810007515Medicaid