Provider Demographics
NPI:1053502245
Name:PEDRAZA CARDOZO, SANDRA LILIANA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LILIANA
Last Name:PEDRAZA CARDOZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9910 FRANKLIN SQUARE DR STE 2110
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4902
Mailing Address - Country:US
Mailing Address - Phone:410-933-6423
Mailing Address - Fax:
Practice Address - Street 1:5255 LOUGHBORO RD NW BLDG B
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2633
Practice Address - Country:US
Practice Address - Phone:202-660-7834
Practice Address - Fax:202-243-5271
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD88226207RX0202X, 207QH0002X, 207QH0002X
WV25091207RG0300X
OH35129930207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810024568Medicaid
OHPENDINGMedicaid
MDD88226OtherLICENSE
4653868780OtherMYUTMB 4653868780
WV2315AMedicare UPIN