Organization
DHP OF NORTHBAY MEDICAL GROUP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SUJAL MANDAVIA M.D. (PRESIDENT)
(865) 693-1000
Entity
Organization
Contact information
Practice address
1200 B GALE WILSON BLVD, FAIRFIELD, CA 94533-3552
(707) 646-4000
Mailing address
265 BROOKVIEW CENTRE WAY, SUITE 400, KNOXVILLE, TN 37919-4052
(865) 693-1000
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
Primary
—
—
208M00000X
Hospitalist Physician
—
—
Other
Enumeration date
07/13/2012
Last updated
07/30/2012
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