Provider Demographics
NPI:1912905266
Name:SAU, PURNIMA (MD)
Entity Type:Individual
Prefix:DR
First Name:PURNIMA
Middle Name:
Last Name:SAU
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 1:8630 FENTON ST
Mailing Address - Street 2:SUITE 906
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-565-3699
Mailing Address - Fax:301-585-1007
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE 906
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-565-3699
Practice Address - Fax:301-585-1007
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0026623207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2099055Medicaid
DCP00773612OtherRAILROAD MEDICARE
MDG65741Medicare UPIN
MD2099055Medicaid
DCP00773612OtherRAILROAD MEDICARE