Provider Demographics
NPI:1235189044
Name:SANDROCK, HAROLD LOYD JR (DO)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:LOYD
Last Name:SANDROCK
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:366 INGRAM DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5856
Mailing Address - Country:US
Mailing Address - Phone:330-758-8772
Mailing Address - Fax:
Practice Address - Street 1:1296 TOD PL NW
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44485-2474
Practice Address - Country:US
Practice Address - Phone:330-306-5030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-2386-S207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0284259Medicaid
OH34-00-2386-SOtherLICENSE
OH0284259Medicaid