1710020995 NPI number — SANJIV K. SAINI M.D.,LLC

Table of content: (NPI 1710020995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710020995 NPI number — SANJIV K. SAINI M.D.,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SANJIV K. SAINI M.D.,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710020995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22335 EXPLORATION DR
Provider Second Line Business Mailing Address:
SUITE 2005
Provider Business Mailing Address City Name:
LEXINGTON PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20653-2014
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-863-7310
Provider Business Mailing Address Fax Number:
301-863-7642

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22335 EXPLORATION DR
Provider Second Line Business Practice Location Address:
SUITE 2005
Provider Business Practice Location Address City Name:
LEXINGTON PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20653-2014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-863-7310
Provider Business Practice Location Address Fax Number:
301-863-7642
Provider Enumeration Date:
02/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAINI
Authorized Official First Name:
SANJIV
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER ADMINISTRATOR
Authorized Official Telephone Number:
301-863-7310

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D31545 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5546265 . This is a "AETNA HEALTHCARE PROVIDER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: D31545 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 8140 SK . This is a "BLUE CROSS PROVIDER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 995802900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: W054 0001 . This is a "FEDERAL BLUE CROSS PROVID" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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