Provider Demographics
NPI:1225399421
Name:CHRISTIANSEN, SANDRA CELIA MAGOS (MD)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:CELIA MAGOS
Last Name:CHRISTIANSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SANDRA
Other - Middle Name:CELIA
Other - Last Name:MAGOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:600 HUMBERSON LN
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-2223
Mailing Address - Country:US
Mailing Address - Phone:301-631-0426
Mailing Address - Fax:
Practice Address - Street 1:707 N MARKET ST
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5246
Practice Address - Country:US
Practice Address - Phone:301-662-5300
Practice Address - Fax:301-631-5572
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045817207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDH98733Medicaid
MDH731H341Medicare UPIN