Healthcare Provider Details

I. General information

NPI: 1407935422
Provider Name (Legal Business Name): SANDIP SAUJI HIRPARA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 05/11/2023
Certification Date: 05/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3430 WORTHINGTON BLVD STE 103
FREDERICK MD
21704-7018
US

IV. Provider business mailing address

610 SOLAREX CT
FREDERICK MD
21703-8624
US

V. Phone/Fax

Practice location:
  • Phone: 240-215-6900
  • Fax:
Mailing address:
  • Phone: 301-663-6162
  • Fax: 301-246-8467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH0062139
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: