MEDICARE: DR. IVAN A SABIO MD

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	225612	NY
2	207R00000X	Internal Medicine Physician	25MA07687800	NJ
3	207R00000X	Internal Medicine Physician	0101262663	VA

General Provider Information

NPI Number	:	1629047709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN A SABIO MD

Provider Business Mailing Address
First Line	:	11350 PEMBROOKE SQ STE 311
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4809
Country	:	US
Telephone Number	:	301-870-0660
Fax Number	:	301-932-8310

Provider Business Practice Location Address
First Line	:	11350 PEMBROOKE SQ STE 311
Second Line	:
City	:	WALDORF
State	:	MD
Zip	:	20603-4809
Country	:	US
Telephone Number	:	301-870-0660
Fax Number	:	301-932-8310

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/20/2023

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