Provider Demographics
NPI:1760429187
Name:SABUNDAYO, ROLAND P (MD)
Entity Type:Individual
Prefix:DR
First Name:ROLAND
Middle Name:P
Last Name:SABUNDAYO
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 62026
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:PHYS OFFICE BLDG., SUITE 907
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-659-0808
Practice Address - Fax:410-547-8523
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0052113207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD326902700Medicaid
MDS190/ 0060OtherBLUE CHOICE
MDKF68/ 548454-01OtherBC/BS OF MD
MDS190/ 0060OtherBLUE CHOICE
MDG48481Medicare UPIN