Healthcare Provider Details

I. General information

NPI: 1215967666
Provider Name (Legal Business Name): SAJJAD A SAVUL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST GROUND RAVDIN
PHILADELPHIA PA
19104-4238
US

IV. Provider business mailing address

3400 SPRUCE ST GROUND RAVDIN
PHILADELPHIA PA
19104-4238
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-6698
  • Fax:
Mailing address:
  • Phone: 215-662-6698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number25MA07305800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberC10006321
License Number StateDE
# 3
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberC10006321
License Number StateDE
# 4
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD066834L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: