SACCO, DAMON C (MD)

Provider Demographics

• NPI: 1700862539
• Name: SACCO, DAMON C (MD)
• Entity Type: Individual
• Prefix: DR
• First Name: DAMON
• Middle Name: C
• Last Name: SACCO
• Gender: M
• Credentials: MD
• Mailing Address - Street 1: PO BOX 6102
• Mailing Address - City: NOVATO
• Mailing Address - State: CA
• Mailing Address - Zip Code: 94948-6102
• Mailing Address - Country: US
• Mailing Address - Phone: 415-884-3418
• Mailing Address - Fax: 415-883-8082
• Practice Address - Street 1: 250 BON AIR RD
• Practice Address - City: GREENBRAE
• Practice Address - State: CA
• Practice Address - Zip Code: 94904-1702
• Practice Address - Country: US
• Practice Address - Phone: 415-925-7080
• Practice Address - Fax: 415-883-8082
• Is Sole Proprietor?: No
• Enumeration Date: 2005-12-22
• Last Update Date: 2020-06-04

Provider Licenses

State	License ID	Taxonomies
NJ	25MA07213700	2085R0202X
CA	G59549	2085R0202X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	2085R0202X	Allopathic & Osteopathic Physicians	Radiology	Diagnostic Radiology

Provider Identifiers

State	Identifier ID	ID Type	Issuer
NV	1700862539	Medicaid
WA	8933496	Other	L&I, CVCP
CA	00G595490	Medicaid
OK	200097380A	Medicaid
NJ	8940304	Medicaid
WA	0144893	Other	L&I
AZ	P00327251	Other	RAILROAD MEDICARE
AZ	111189	Medicaid
CO	1307792	Medicaid
WA	8169682	Medicaid
CA	300121758	Other	RAILROAD MEDICARE
WA	300123272	Other	RAILROAD MEDICARE
CA	CH761Y	Medicare PIN
CA	00G5954922	Medicare PIN
CA	300121758	Other	RAILROAD MEDICARE
AZ	111189	Medicaid
CA	00G5954911	Medicare PIN
CA	CH761W	Medicare PIN
WA	300123272	Other	RAILROAD MEDICARE
HI	CO206Z	Medicare PIN
CO	CO300533	Medicare PIN
WA	AB07758	Medicare PIN
WA	8933496	Other	L&I, CVCP
CA	00G5954915	Medicare PIN
CA	00G5954912	Medicare PIN
CA	CH761V	Medicare PIN
CA	CH761X	Medicare PIN
CA	00G595497	Medicare PIN
CA	00G595493	Medicare PIN
CA	00G5954923	Medicare PIN
NE	099984001	Medicare PIN
CA	00G5954920	Medicare PIN
CA	CH761T	Medicare PIN
CA	CH761U	Medicare PIN