Provider Demographics
NPI:1164419610
Name:SANFORD, ROBERT GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GEORGE
Last Name:SANFORD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1703
Mailing Address - Country:US
Mailing Address - Phone:717-761-3505
Mailing Address - Fax:717-761-4293
Practice Address - Street 1:1845 CENTER ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1703
Practice Address - Country:US
Practice Address - Phone:717-761-3505
Practice Address - Fax:717-761-4293
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012670E207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB40132Medicare UPIN