Provider Demographics
NPI:1083771463
Name:SAHA, PROSHANTA (MD)
Entity Type:Individual
Prefix:DR
First Name:PROSHANTA
Middle Name:
Last Name:SAHA
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 1:4988 STATE HWY 30
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:AMSTERDAM
Mailing Address - State:NY
Mailing Address - Zip Code:12010-4614
Mailing Address - Country:US
Mailing Address - Phone:518-842-3545
Mailing Address - Fax:
Practice Address - Street 1:4988 STATE HWY 30
Practice Address - Street 2:1ST FLOOR
Practice Address - City:AMSTERDAM
Practice Address - State:NY
Practice Address - Zip Code:12010-4614
Practice Address - Country:US
Practice Address - Phone:518-842-3545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2013-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121785208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00515522Medicaid