Provider Demographics
NPI:1174770945
Name:SAHA, SUPARNA (MD)
Entity type:Individual
Prefix:
First Name:SUPARNA
Middle Name:
Last Name:SAHA
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 1:110 GRAY ST
Mailing Address - Street 2:APT 2159
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77002-8500
Mailing Address - Country:US
Mailing Address - Phone:510-386-0468
Mailing Address - Fax:
Practice Address - Street 1:110 GRAY ST
Practice Address - Street 2:APT 3155
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77002-8500
Practice Address - Country:US
Practice Address - Phone:713-523-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-25
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP20036196208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice