Provider Demographics
NPI:1629047709
Name:SABIO, IVAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:A
Last Name:SABIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:11350 PEMBROOKE SQ STE 311
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-4809
Mailing Address - Country:US
Mailing Address - Phone:301-870-0660
Mailing Address - Fax:301-932-8310
Practice Address - Street 1:11350 PEMBROOKE SQ STE 311
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-4809
Practice Address - Country:US
Practice Address - Phone:301-870-0660
Practice Address - Fax:301-932-8310
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY225612207R00000X
NJ25MA07687800207R00000X
VA0101262663207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH82525Medicare UPIN