MEDICARE: SAGAR JAYANT PANSE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD429573	PA
2	207RN0300X	Nephrology Physician	065864	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033132212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAGAR JAYANT PANSE M.D.

Provider Business Mailing Address
First Line	:	890 2ND ST
Second Line	:	SUITE 201
City	:	MACON
State	:	GA
Zip	:	31201-6863
Country	:	US
Telephone Number	:	478-745-4322
Fax Number	:	478-750-8789

Provider Business Practice Location Address
First Line	:	890 2ND ST
Second Line	:	SUITE 201
City	:	MACON
State	:	GA
Zip	:	31201-6863
Country	:	US
Telephone Number	:	478-745-4322
Fax Number	:	478-750-8789

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	05/12/2015

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