Provider Demographics
NPI:1093094088
Name:DAVID G. SANDERSON, DPM, PC
Entity Type:Organization
Organization Name:DAVID G. SANDERSON, DPM, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-834-7240
Mailing Address - Street 1:238 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-2304
Mailing Address - Country:US
Mailing Address - Phone:814-834-7240
Mailing Address - Fax:814-781-6581
Practice Address - Street 1:238 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-2304
Practice Address - Country:US
Practice Address - Phone:814-834-7240
Practice Address - Fax:814-781-6581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC004253L261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU62112Medicare UPIN