Provider Demographics
NPI:1093967077
Name:SANDRA V. KRISTIANSEN, MD, PC
Entity Type:Organization
Organization Name:SANDRA V. KRISTIANSEN, MD, PC
Other - Org Name:VEIN CLINIC OF NEW ENGLAND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:V
Authorized Official - Last Name:KRISTIANSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-870-5900
Mailing Address - Street 1:7 REED AVE
Mailing Address - Street 2:
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581-3643
Mailing Address - Country:US
Mailing Address - Phone:508-870-5900
Mailing Address - Fax:508-870-5960
Practice Address - Street 1:176 E MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581-1763
Practice Address - Country:US
Practice Address - Phone:508-870-5900
Practice Address - Fax:508-870-5960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75153202K00000X, 207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAA20391Medicare PIN
MAE19216Medicare UPIN