Healthcare Provider Details

I. General information

NPI: 1508932666
Provider Name (Legal Business Name): PRADIP SAHDEV MD FACS FICS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 OLD WASHINGTON ROAD STE 202
WALDORF MD
20602
US

IV. Provider business mailing address

3450 OLD WASHINGTON ROAD STE 202
WALDORF MD
20602
US

V. Phone/Fax

Practice location:
  • Phone: 301-645-3590
  • Fax: 301-705-1941
Mailing address:
  • Phone: 301-645-3590
  • Fax: 301-705-1941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0047202
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberD0047202
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberD0047202
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: