Provider Demographics
NPI:1629394390
Name:SAHA, SAM KUMAR
Entity type:Individual
Prefix:
First Name:SAM
Middle Name:KUMAR
Last Name:SAHA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W OAKLAND AVE STE 310
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2192
Mailing Address - Country:US
Mailing Address - Phone:423-302-6565
Mailing Address - Fax:
Practice Address - Street 1:315 MEDICAL PARK DR
Practice Address - Street 2:SUITE 202
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-1902
Practice Address - Country:US
Practice Address - Phone:704-403-1911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-20
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1354962084N0400X
ORMD1922462084N0400X
MO20240243052084N0400X
TN589212084N0400X
IL0361489152084N0400X
NY2988772084N0400X
FLME1399422084N0400X
VA01012718402084N0400X
NH195432084N0400X
IN01081504A2084N0400X
NC2013-018792084N0400X
MI43011171242084N0400X
LA3383242084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3119493Medicaid
SCNC2251Medicaid
NC1629394390Medicaid