Provider Demographics
NPI:1124200654
Name:MACHALA, SASA (MD)
Entity Type:Individual
Prefix:DR
First Name:SASA
Middle Name:
Last Name:MACHALA
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 1:821 N EUTAW ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-4648
Mailing Address - Country:US
Mailing Address - Phone:410-669-1393
Mailing Address - Fax:443-524-0749
Practice Address - Street 1:821 N EUTAW ST
Practice Address - Street 2:SUITE 407
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-4648
Practice Address - Country:US
Practice Address - Phone:410-669-1393
Practice Address - Fax:443-524-0749
Is Sole Proprietor?:No
Enumeration Date:2007-11-27
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0072511207RC0200X, 207RP1001X
CAA134420207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD335002900Medicaid
MD335002900Medicaid