Provider Demographics
NPI:1881683068
Name:SAHAY, VANDANA (MD)
Entity Type:Individual
Prefix:
First Name:VANDANA
Middle Name:
Last Name:SAHAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:497 MAIN ST STE 4B
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:MA
Mailing Address - Zip Code:01450-1298
Mailing Address - Country:US
Mailing Address - Phone:978-784-9975
Mailing Address - Fax:978-784-9982
Practice Address - Street 1:497 MAIN ST
Practice Address - Street 2:SUITE 4B
Practice Address - City:GROTON
Practice Address - State:MA
Practice Address - Zip Code:01450-1298
Practice Address - Country:US
Practice Address - Phone:978-784-9975
Practice Address - Fax:978-784-9982
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA209130207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMX7049OtherPTAN
MAMX7055OtherPTAN 41
MA0142999Medicaid
MA0142999Medicaid
MAMX7055OtherPTAN 41