Provider Demographics
NPI:1770513863
Name:SAUNDERS, MITCHELL A (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:A
Last Name:SAUNDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:220 BELLE MEAD RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:E. SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733
Mailing Address - Country:US
Mailing Address - Phone:631-941-2273
Mailing Address - Fax:631-941-2501
Practice Address - Street 1:1320 STONY BROOK RD BUILDING D SUITE 100
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-2222
Practice Address - Country:US
Practice Address - Phone:631-941-2273
Practice Address - Fax:631-941-2501
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY164946207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01176145Medicaid
NYD91965Medicare UPIN
NY01176145Medicaid