Provider Demographics
NPI:1710020995
Name:SANJIV K. SAINI M.D.,LLC
Entity Type:Organization
Organization Name:SANJIV K. SAINI M.D.,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:K
Authorized Official - Last Name:SAINI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-863-7310
Mailing Address - Street 1:22335 EXPLORATION DR
Mailing Address - Street 2:SUITE 2005
Mailing Address - City:LEXINGTON PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20653-2014
Mailing Address - Country:US
Mailing Address - Phone:301-863-7310
Mailing Address - Fax:301-863-7642
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD31545174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD5546265OtherAETNA HEALTHCARE PROVIDER
MDD31545OtherSTATE LICENSE NUMBER
MD8140 SKOtherBLUE CROSS PROVIDER
MD995802900Medicaid
DCW054 0001OtherFEDERAL BLUE CROSS PROVID
MD995802900Medicaid
MD5546265OtherAETNA HEALTHCARE PROVIDER