=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356270409
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAGE HEALTHCARE SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2026
-----------------------------------------------------
Last Update Date | 05/15/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6158 FAIRBOURNE CT
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21076-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-856-0529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6158 FAIRBOURNE CT
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21076-1000
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-856-0529
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | NURSE PRACTITIONER
-----------------------------------------------------
Name | NTAOBASI PATRICK UDEH
-----------------------------------------------------
Credential | AGACNP-BC
-----------------------------------------------------
Telephone | 240-856-0529
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LG0600X
-----------------------------------------------------
Taxonomy Name | Gerontology Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------