Provider Demographics
NPI:1295788941
Name:PENDSE, SAGUN (MD)
Entity type:Individual
Prefix:
First Name:SAGUN
Middle Name:
Last Name:PENDSE
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 1:360 MIDDLETOWN BLVD
Mailing Address - Street 2:STE 402
Mailing Address - City:LANGHORNE
Mailing Address - State:PA
Mailing Address - Zip Code:19047-1863
Mailing Address - Country:US
Mailing Address - Phone:215-757-6200
Mailing Address - Fax:
Practice Address - Street 1:360 MIDDLETOWN BLVD
Practice Address - Street 2:STE 402
Practice Address - City:LANGHORNE
Practice Address - State:PA
Practice Address - Zip Code:19047-1863
Practice Address - Country:US
Practice Address - Phone:215-757-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DECI0007361207W00000X
DECI-0007361207W00000X
PAMD435508207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000039626Medicaid
DE152919Medicare UPIN
DE020073C37Medicare PIN
DE1000039626Medicaid