Basic Information
| Provider Information | |||||||||
| NPI: | 1831152511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAHA | ||||||||
| FirstName: | MADHUMITA | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3170 KETTERING BLVD | ||||||||
| Address2: | BLDG B 3RD FL | ||||||||
| City: | MORAINE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454391924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9379913188 | ||||||||
| FaxNumber: | 9372239811 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 MCKNIGHT DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MIDDLETOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450444890 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132176400 | ||||||||
| FaxNumber: | 5132176037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/11/2006 | ||||||||
| LastUpdateDate: | 10/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 35075762 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 64025570 | 05 | KY | MEDICAID | 2108730 | 05 | OH | MEDICAID | 2501681 | 01 | UNITED | OTHER | 283895 | 01 | OH | AMERIGROUP | OTHER | 200239780 | 05 | IN | MEDICAID | 2118152 | 01 | AETNA | OTHER |