MEDICARE: DR. PRANTIK SAHA 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	208000000X	Pediatrics Physician	210091	NY
2	2080P0204X	Pediatric Emergency Medicine (Pediatrics) Physician	210091	NY

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	:	1881666519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRANTIK SAHA M.D

Provider Business Mailing Address
First Line	:	PO BOX 95000-2388
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19195-2388
Country	:	US
Telephone Number	:	212-308-1112
Fax Number	:	212-308-1616

Provider Business Practice Location Address
First Line	:	2637 BROADWAY
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-5022
Country	:	US
Telephone Number	:	917-921-6219
Fax Number	:	212-787-1606

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

Provider Enumeration Date	:	02/06/2006
Last Update Date	:	04/29/2021

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