Healthcare Provider Details

I. General information

NPI: 1942279930
Provider Name (Legal Business Name): TRIDIV SAHA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 SW 34TH CIR BLDG.200
OCALA FL
34474-3392
US

IV. Provider business mailing address

3309 SW 34TH CIR BLDG. 200
OCALA FL
34474-3392
US

V. Phone/Fax

Practice location:
  • Phone: 352-237-5400
  • Fax: 352-237-4437
Mailing address:
  • Phone: 352-237-5400
  • Fax: 352-237-4437

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME50866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: