Healthcare Provider Details

I. General information

NPI: 1356270409
Provider Name (Legal Business Name): SAGE HEALTHCARE SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6158 FAIRBOURNE CT
HANOVER MD
21076-1000
US

IV. Provider business mailing address

6158 FAIRBOURNE CT
HANOVER MD
21076-1000
US

V. Phone/Fax

Practice location:
  • Phone: 240-856-0529
  • Fax:
Mailing address:
  • Phone: 240-856-0529
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: NTAOBASI PATRICK UDEH
Title or Position: NURSE PRACTITIONER
Credential: AGACNP-BC
Phone: 240-856-0529