Provider Demographics
NPI:1457376683
Name:SAGAR, VIDYA (MD)
Entity Type:Individual
Prefix:
First Name:VIDYA
Middle Name:
Last Name:SAGAR
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 1:2725 PARK DR
Mailing Address - Street 2:STE 5
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33763-1023
Mailing Address - Country:US
Mailing Address - Phone:727-733-3500
Mailing Address - Fax:727-734-3606
Practice Address - Street 1:2725 PARK DR
Practice Address - Street 2:STE 5
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33763-1023
Practice Address - Country:US
Practice Address - Phone:727-733-3500
Practice Address - Fax:727-734-3606
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2018-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL75830207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL254191200Medicaid
FL43526Medicare ID - Type Unspecified
FL254191200Medicaid