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General NPI Number Information
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NPI Number | 1053388777
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Entity Type | Individual
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Provider Name | TAHIRA SAIFUDDIN MD
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Gender | Female
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 360 BROADWAY STE 100
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City | BANGOR
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State | ME
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Zip | 04401-3985
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Country | US
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Telephone | 207-907-3550
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Fax | 207-907-3562
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Provider Business Mailing Address
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Address Line | 11035 W SYCAMORE HILLS DR STE 1
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City | FORT WAYNE
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State | IN
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Zip | 46814-9310
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Country | US
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Telephone | 260-241-1233
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Fax | 260-373-9740
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | MD23200
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License Number State | ME
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 01061185A
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License Number State | IN
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