Provider Demographics
NPI:1679685101
Name:SAHA, SANDEEP AJOY (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:AJOY
Last Name:SAHA
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:PO BOX 886
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97308-0886
Mailing Address - Country:US
Mailing Address - Phone:503-814-4440
Mailing Address - Fax:503-814-4444
Practice Address - Street 1:610 HAWTHORNE AVE SE STE 110
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-814-4440
Practice Address - Fax:503-814-4444
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD182348207RC0000X, 207R00000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500726947Medicaid