Provider Demographics
NPI:1598805293
Name:SAINI, SANJIV K (MD)
Entity Type:Individual
Prefix:DR
First Name:SANJIV
Middle Name:K
Last Name:SAINI
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 1:3168 BRAVERTON ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:EDGEWATER
Mailing Address - State:MD
Mailing Address - Zip Code:21037
Mailing Address - Country:US
Mailing Address - Phone:410-956-7777
Mailing Address - Fax:
Practice Address - Street 1:22335 EXPLORATION DR
Practice Address - Street 2:SUITE 2005
Practice Address - City:LEXINGTON PARK
Practice Address - State:MD
Practice Address - Zip Code:20653-2014
Practice Address - Country:US
Practice Address - Phone:301-863-7310
Practice Address - Fax:301-863-7642
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0031545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD995802900Medicaid
MD995802900Medicaid
F15711Medicare UPIN
MD131NMedicare ID - Type UnspecifiedMEDICARE