Provider Demographics
NPI:1710906862
Name:BABU, SAJJA L (MD)
Entity Type:Individual
Prefix:DR
First Name:SAJJA
Middle Name:L
Last Name:BABU
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 1:708 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-3349
Mailing Address - Country:US
Mailing Address - Phone:219-324-5335
Mailing Address - Fax:219-324-5335
Practice Address - Street 1:708 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-3349
Practice Address - Country:US
Practice Address - Phone:219-324-5335
Practice Address - Fax:219-324-5335
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01027692B2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000086611OtherANTHEM/BLUE CROSS
IN100162990Medicaid
IN100162990Medicaid
IN000000086611OtherANTHEM/BLUE CROSS