Provider Demographics
NPI:1043323405
Name:EDWARD D SABOL MD PA
Entity type:Organization
Organization Name:EDWARD D SABOL MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:SABOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-732-7435
Mailing Address - Street 1:1500 SE 17TH ST
Mailing Address - Street 2:BLDG #200
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4621
Mailing Address - Country:US
Mailing Address - Phone:352-351-0060
Mailing Address - Fax:352-351-4130
Practice Address - Street 1:1500 SE 17TH ST
Practice Address - Street 2:BLDG #200
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4621
Practice Address - Country:US
Practice Address - Phone:352-351-0060
Practice Address - Fax:352-351-4130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL19512207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD54767Medicare UPIN
FL42094Medicare ID - Type Unspecified