Healthcare Provider Details

I. General information

NPI: 1063790590
Provider Name (Legal Business Name): PRABHJOT SAGGU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2011
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4257 58TH AVE APARTMENT 7
BLADENSBURG MD
20710-1926
US

IV. Provider business mailing address

4257, 58TH AVENUE APARTMENT 7
BLADENSBURG MD
20710-1926
US

V. Phone/Fax

Practice location:
  • Phone: 301-000-0000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0078002
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD78002
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: