Provider Demographics
NPI:1205893542
Name:MEDHANE, SABA (MD)
Entity type:Individual
Prefix:DR
First Name:SABA
Middle Name:
Last Name:MEDHANE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3803
Mailing Address - Country:US
Mailing Address - Phone:301-468-8999
Mailing Address - Fax:
Practice Address - Street 1:6000 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3803
Practice Address - Country:US
Practice Address - Phone:301-468-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058994207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP16939OtherCAREFIRST POS PROVIDER #
MD8144961OtherMAMSI PROVIDER NUMBER
MD1132319OtherCIGNA PROVIDER NUMBER
MD64771401OtherBSMD PROVIDER NUMBER
MD7950732OtherAETNA HMO PROVIDER NUMBER
MD8144961OtherALLIANCE PROVIDER NUMBER
MD8144961OtherOPTIMUM CHOICE PROVIDER #
MD9070 0023OtherBSDC PROVIDER NUMBER
MD7950732OtherAETNA PPO PROVIDER NUMBER
MD8144961OtherMDIPA PROVIDER NUMBER
MD521186611OtherUNITED HEALTHCARE PROV #
MD1132319OtherCIGNA PROVIDER NUMBER
MD7950732OtherAETNA HMO PROVIDER NUMBER