Provider Demographics
NPI:1003001884
Name:SAHA, LUCILLE T (MD)
Entity Type:Individual
Prefix:
First Name:LUCILLE
Middle Name:T
Last Name:SAHA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4088 OLD PLANTATION LOOP
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-1306
Mailing Address - Country:US
Mailing Address - Phone:810-691-2407
Mailing Address - Fax:
Practice Address - Street 1:1723 MAHAN CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5428
Practice Address - Country:US
Practice Address - Phone:850-878-5310
Practice Address - Fax:850-878-4483
Is Sole Proprietor?:No
Enumeration Date:2007-09-13
Last Update Date:2022-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301061270207Q00000X
FLME142052207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N83380004Medicare PIN
MIH52654Medicare UPIN