Provider Demographics
NPI:1275593485
Name:SAHOO, DILLISWAR (MD)
Entity Type:Individual
Prefix:
First Name:DILLISWAR
Middle Name:
Last Name:SAHOO
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 1:48 W PHILLIP ST
Mailing Address - Street 2:
Mailing Address - City:COALDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18218
Mailing Address - Country:US
Mailing Address - Phone:570-645-2184
Mailing Address - Fax:570-645-3297
Practice Address - Street 1:48 W PHILLIP ST
Practice Address - Street 2:
Practice Address - City:COALDALE
Practice Address - State:PA
Practice Address - Zip Code:18218
Practice Address - Country:US
Practice Address - Phone:570-645-2184
Practice Address - Fax:570-645-3297
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026761E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001390391OtherHIGHMARK BLUE SHIELD
B35445Medicare UPIN
PA090218Medicare PIN