Provider Demographics
NPI:1235182403
Name:SANCHEZ, IVAN ORLANDO (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:ORLANDO
Last Name:SANCHEZ
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:PO BOX 601151
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-1151
Mailing Address - Country:US
Mailing Address - Phone:704-480-1087
Mailing Address - Fax:704-480-1150
Practice Address - Street 1:201 E GROVER ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3917
Practice Address - Country:US
Practice Address - Phone:704-480-1087
Practice Address - Fax:704-480-1150
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC009800687174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1238QOtherBSNC
NC891238QMedicaid
NC2279795Medicare PIN
NCH08538Medicare UPIN