Provider Demographics
NPI:1063685014
Name:HAREWOOD, SANDRA K (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:K
Last Name:HAREWOOD
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 1:235 W NATIONAL RD.
Mailing Address - Street 2:
Mailing Address - City:VANDALIA
Mailing Address - State:OH
Mailing Address - Zip Code:45377-1969
Mailing Address - Country:US
Mailing Address - Phone:937-898-3600
Mailing Address - Fax:937-898-2731
Practice Address - Street 1:235 W NATIONAL RD
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-1969
Practice Address - Country:US
Practice Address - Phone:937-898-3600
Practice Address - Fax:937-898-2731
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.090989207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHA0825573OtherMEDICARE PTAN
OH35.090989OtherSTATE MEDICAL BOARD
OH0861232Medicaid