Provider Demographics
NPI:1861550386
Name:SAGAR, SANDEEP (MD)
Entity type:Individual
Prefix:
First Name:SANDEEP
Middle Name:
Last Name:SAGAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 GRAMPIAN BLVD
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-1900
Mailing Address - Country:US
Mailing Address - Phone:570-326-8723
Mailing Address - Fax:570-326-8922
Practice Address - Street 1:740 HIGH ST
Practice Address - Street 2:SUITE 2001
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3102
Practice Address - Country:US
Practice Address - Phone:570-321-2800
Practice Address - Fax:570-321-3351
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459156207RC0000X, 207RC0001X
TXP1401207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX287075001Medicaid
TXTXB141250Medicare PIN
MNP00739706OtherMEDICARE, RAILROAD
MN060002405Medicare PIN
MN69911500Medicaid
MNI72107Medicare UPIN