Provider Demographics
NPI:1104862309
Name:RITLAND, SANDRA KALVODA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KALVODA
Last Name:RITLAND
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 1:17500 SE 392ND ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98092-9705
Mailing Address - Country:US
Mailing Address - Phone:253-939-6648
Mailing Address - Fax:253-735-6705
Practice Address - Street 1:17500 SE 392ND ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98092-9705
Practice Address - Country:US
Practice Address - Phone:253-939-6648
Practice Address - Fax:253-735-6705
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2159RIOtherREGENCE BLUESHIELD INS
WA5736RIOtherREGENCE/STECK
WA0237234OtherL&I/STECK
WA5997RIOtherREGENCE BLUESHIELD INS
WA8400921Medicaid
WA5124RIOtherREGENCE BLUESHIELD INS
WA8903810OtherDEPT L&I, CRIME VICTIMS
WA4215RIOtherREGENCE BLUESHIELD INS
WA4215RIOtherREGENCE BLUESHIELD INS
WA5997RIOtherREGENCE BLUESHIELD INS
0568510001Medicare NSC
G8874131Medicare PIN
WA0237234OtherL&I/STECK