Basic Information
Provider Information | |||||||||
NPI: | 1376520254 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | SENGAR | ||||||||
FirstName: | ASHVINI | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 509 ENERGY CENTER BLVD STE 804 | ||||||||
Address2: |   | ||||||||
City: | NORTHPORT | ||||||||
State: | AL | ||||||||
PostalCode: | 354732798 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2053457892 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 355 S 2ND ST | ||||||||
Address2: |   | ||||||||
City: | GADSDEN | ||||||||
State: | AL | ||||||||
PostalCode: | 359015202 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2565470536 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/30/2005 | ||||||||
LastUpdateDate: | 06/15/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/15/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 22433 | NE | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RH0003X | 30196 | AL | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
ID | Type | State | Issuer | Description | 240202 | 01 | NE | MIDLANDS CHOICE IND NUMBE | OTHER | 01259 | 01 | NE | BLUE CROSS IND NUMBER | OTHER | 200379290A | 05 | KS |   | MEDICAID |