Healthcare Provider Details

I. General information

NPI: 1912079724
Provider Name (Legal Business Name): PHILIP D. SARDAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1631 CREEKSIDE DR STE 102
FOLSOM CA
95630-3820
US

IV. Provider business mailing address

1631 CREEKSIDE DR STE 102
FOLSOM CA
95630-3820
US

V. Phone/Fax

Practice location:
  • Phone: 916-250-0377
  • Fax: 916-250-0378
Mailing address:
  • Phone: 916-250-0377
  • Fax: 916-250-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC50312
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: