Provider Demographics
NPI:1093782203
Name:NOLL, SANDRA LEE (DPM)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:LEE
Last Name:NOLL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:LEE
Other - Last Name:NOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:2714 MERCER RD
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16105-1422
Mailing Address - Country:US
Mailing Address - Phone:724-654-6660
Mailing Address - Fax:
Practice Address - Street 1:2714 MERCER RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1422
Practice Address - Country:US
Practice Address - Phone:724-654-6660
Practice Address - Fax:724-657-8330
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005542213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAU97149Medicare UPIN
PA7556580001Medicare NSC