Provider Demographics
NPI:1851321897
Name:DILLISWAR SAHOO MD PC
Entity Type:Organization
Organization Name:DILLISWAR SAHOO MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DILLISWAR
Authorized Official - Middle Name:
Authorized Official - Last Name:SAHOO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-645-2184
Mailing Address - Street 1:PO BOX 25
Mailing Address - Street 2:
Mailing Address - City:COALDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18218-0025
Mailing Address - Country:US
Mailing Address - Phone:570-645-2184
Mailing Address - Fax:570-645-3297
Practice Address - Street 1:48 W PHILLIPS ST
Practice Address - Street 2:
Practice Address - City:COALDALE
Practice Address - State:PA
Practice Address - Zip Code:18218-1437
Practice Address - Country:US
Practice Address - Phone:570-645-2184
Practice Address - Fax:570-645-3297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008909790002Medicaid
1390391OtherHIGHMARK BS
PA060001056OtherTRAVELERS MEDICARE
PA060001056OtherTRAVELERS MEDICARE