Basic Information
Provider Information | |||||||||
NPI: | 1891791729 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MAGGE | ||||||||
FirstName: | SATHISH | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 380 SUMMIT AVE | ||||||||
Address2: |   | ||||||||
City: | STEUBENVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 439522667 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7402837597 | ||||||||
FaxNumber: | 7402837190 | ||||||||
Practice Location | |||||||||
Address1: | 401 MARKET ST STE 200 | ||||||||
Address2: |   | ||||||||
City: | STEUBENVILLE | ||||||||
State: | OH | ||||||||
PostalCode: | 439522846 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7402825000 | ||||||||
FaxNumber: | 7402825233 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/24/2005 | ||||||||
LastUpdateDate: | 05/07/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/07/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 18557 | WV | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | MD047734L | PA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0000X | 35.070729 | OH | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
ID | Type | State | Issuer | Description | 0016009930006 | 05 | PA |   | MEDICAID | 0086460000 | 05 | WV |   | MEDICAID | P00999632 | 01 | OH | RR MEDICARE | OTHER | 0267027 | 05 | OH |   | MEDICAID |