Healthcare Provider Details

I. General information

NPI: 1679831770
Provider Name (Legal Business Name): SAGA MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 04/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

847 QUINCE ORCHARD BLVD STE D
GAITHERSBURG MD
20878-1677
US

IV. Provider business mailing address

847 QUINCE ORCHARD BLVD STE D
GAITHERSBURG MD
20878-1677
US

V. Phone/Fax

Practice location:
  • Phone: 301-330-2664
  • Fax: 301-330-2664
Mailing address:
  • Phone: 301-330-2664
  • Fax: 301-330-2664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberD004338
License Number StateMD

VIII. Authorized Official

Name: DR. GRACE E SAGAYADAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-330-2664