Basic Information
| Provider Information | |||||||||
| NPI: | 1003001884 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SAHA | ||||||||
| FirstName: | LUCILLE | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4088 OLD PLANTATION LOOP | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323111306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8106912407 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1723 MAHAN CENTER BLVD | ||||||||
| Address2: | |||||||||
| City: | TALLAHASSEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 323085428 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508785310 | ||||||||
| FaxNumber: | 8508784483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2007 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301061270 | MI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207QH0002X | ME142052 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine |
No ID Information.