Provider Demographics
NPI:1205848256
Name:EDDIE S SAW MD PA
Entity Type:Organization
Organization Name:EDDIE S SAW MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-398-0121
Mailing Address - Street 1:135 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921
Mailing Address - Country:US
Mailing Address - Phone:410-398-0121
Mailing Address - Fax:
Practice Address - Street 1:135 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921
Practice Address - Country:US
Practice Address - Phone:410-398-0121
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-11
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD171136208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD007401200Medicaid
7373Medicare ID - Type Unspecified
MD007401200Medicaid