Healthcare Provider Details

I. General information

NPI: 1720022460
Provider Name (Legal Business Name): VIDYA V SAGAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4755 OGLETOWN STANTON ROAD
NEWARK DE
19713
US

IV. Provider business mailing address

PO BOX 3012
WILMINGTON DE
19804-0012
US

V. Phone/Fax

Practice location:
  • Phone: 302-733-1525
  • Fax: 302-733-1518
Mailing address:
  • Phone: 302-224-5678
  • Fax: 302-224-2848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberC1-0000736
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: