1528154267 NPI number — DR. SANDRA DIANE STRATFORD MD, MSC

Table of content: DR. SANDRA DIANE STRATFORD MD, MSC (NPI 1528154267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528154267 NPI number — DR. SANDRA DIANE STRATFORD MD, MSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STRATFORD
Provider First Name:
SANDRA
Provider Middle Name:
DIANE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD, MSC
Provider Gender Code:
F

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:
1528154267
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:
75 CAMBRIDGE PARKWAY
Provider Second Line Business Mailing Address:
E1106
Provider Business Mailing Address City Name:
CAMBRIDGE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-290-2213
Provider Business Mailing Address Fax Number:
781-290-2215

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 TRAPELO RD
Provider Second Line Business Practice Location Address:
SUITE 176
Provider Business Practice Location Address City Name:
WALTHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-290-2210
Provider Business Practice Location Address Fax Number:
781-290-2215
Provider Enumeration Date:
10/04/2006

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: 2083P0500X , with the licence number:  205316 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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