MEDICARE: KENNETH E SAUM 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	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	036111948	IL
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician	0101840531	VA

General Provider Information

NPI Number	:	1255312609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENNETH E SAUM M.D.

Provider Business Mailing Address
First Line	:	2010 ATHERHOLT RD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-1106
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2410 ATHERHOLT RD
Second Line	:
City	:	LYNCHBURG
State	:	VA
Zip	:	24501-2148
Country	:	US
Telephone Number	:	434-200-2212
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	11/04/2015

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