Healthcare Provider Details

I. General information

NPI: 1871783456
Provider Name (Legal Business Name): SABA PEDIATRIC MEDICINE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15225 SHADY GROVE RD SUITE 208
ROCKVILLE MD
20850-3258
US

IV. Provider business mailing address

15225 SHADY GROVE RD SUITE 208
ROCKVILLE MD
20850-3258
US

V. Phone/Fax

Practice location:
  • Phone: 301-838-8977
  • Fax: 301-838-0176
Mailing address:
  • Phone: 301-838-8977
  • Fax: 301-838-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0047734
License Number StateMD

VIII. Authorized Official

Name: CHRISTINE L SABA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 301-838-8977