Healthcare Provider Details

I. General information

NPI: 1790273977
Provider Name (Legal Business Name): SAJANA MAHARJAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 GOOD SAMARITAN WAY
MOUNT VERNON IL
62864-2402
US

IV. Provider business mailing address

1 GOOD SAMARITAN WAY
MOUNT VERNON IL
62864-2402
US

V. Phone/Fax

Practice location:
  • Phone: 618-899-2497
  • Fax: 618-899-4768
Mailing address:
  • Phone: 618-899-2497
  • Fax: 918-579-5762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number57246325
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37290
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number036158545
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: