Basic Information
| Provider Information | |||||||||
| NPI: | 1598956286 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAU | ||||||||
| FirstName: | INDRANIL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 S 2ND ST STE 2F | ||||||||
| Address2: | |||||||||
| City: | HARRISBURG | ||||||||
| State: | PA | ||||||||
| PostalCode: | 171041612 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179880090 | ||||||||
| FaxNumber: | 7172215320 | ||||||||
| Practice Location | |||||||||
| Address1: | 3 WALNUT ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | LEMOYNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 170431168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7179880090 | ||||||||
| FaxNumber: | 7172215320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2007 | ||||||||
| LastUpdateDate: | 01/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | MD431821 | PA | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0120X | MD431821 | PA | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
No ID Information.