Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0202X | Pediatric Cardiologist | MD19036 | DC |
NPI | 1154415511 |
---|---|
Provider Name | Craig A, Sable |
First Address | Atlanta, GA 30374-4785 |
Second Address | Washington, DC 20010-2978 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 02/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
028041600 | (05) | DC |
0494 | CAREFIRST (01) | DC |
605231200 | (05) | MD |
672109 | (05) | VA |
G12329 | (02) |