MEDICARE: SAGE HEALTH MARYLAND LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1770294324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAGE HEALTH MARYLAND LLC

Provider Business Mailing Address
First Line	:	501 UNION ST SUITE 545
Second Line	:	PMB 82739
City	:	NASHVILLE
State	:	TN
Zip	:	37219-1876
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6660 SECURITY BLVD
Second Line	:
City	:	WOODLAWN
State	:	MD
Zip	:	21207-4012
Country	:	US
Telephone Number	:	443-380-0552
Fax Number	:

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	JOHN HASKELL
Credential	:
Telephone Number	:	615-988-9771

Provider Enumeration Date	:	12/05/2022
Last Update Date	:	08/01/2024

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Directions to “SAGE HEALTH MARYLAND LLC ” Practice Location

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