1003882556 NPI number — FRANK THEODORE SANDSORUM JR. MD

Table of content: FRANK THEODORE SANDSORUM JR. MD (NPI 1003882556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003882556 NPI number — FRANK THEODORE SANDSORUM JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANDSORUM
Provider First Name:
FRANK
Provider Middle Name:
THEODORE
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003882556
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2300 COMPUTER RD
Provider Second Line Business Mailing Address:
STE E25
Provider Business Mailing Address City Name:
WILLOW GROVE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-659-8080
Provider Business Mailing Address Fax Number:
215-659-0977

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 COMPUTER RD
Provider Second Line Business Practice Location Address:
STE E25
Provider Business Practice Location Address City Name:
WILLOW GROVE
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-659-8080
Provider Business Practice Location Address Fax Number:
215-659-0977
Provider Enumeration Date:
02/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  MD012726E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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