Provider Demographics
NPI:1033132212
Name:PANSE, SAGAR JAYANT (MD)
Entity Type:Individual
Prefix:
First Name:SAGAR
Middle Name:JAYANT
Last Name:PANSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 2ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-6863
Mailing Address - Country:US
Mailing Address - Phone:478-745-4322
Mailing Address - Fax:478-750-8789
Practice Address - Street 1:890 2ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6863
Practice Address - Country:US
Practice Address - Phone:478-745-4322
Practice Address - Fax:478-750-8789
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD429573207R00000X
GA065864207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003110313AMedicaid