Provider Demographics
NPI:1588059059
Name:BAGEWADI, SABA (MD)
Entity type:Individual
Prefix:
First Name:SABA
Middle Name:
Last Name:BAGEWADI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AYLA
Other - Middle Name:
Other - Last Name:BAGEWADI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1011
Mailing Address - Country:US
Mailing Address - Phone:207-351-2478
Mailing Address - Fax:207-351-2216
Practice Address - Street 1:2160 S 1ST AVE
Practice Address - Street 2:LOYOLA UNIVERSITY MEDICAL CENTER, DEPT. OF PEDIATRICS
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-3328
Practice Address - Country:US
Practice Address - Phone:708-327-9124
Practice Address - Fax:708-327-9111
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-01
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA169110208000000X, 208M00000X
IL00000000208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist