Provider Demographics
NPI:1275526766
Name:SAUDER, KURTIS LAMAR (MD)
Entity Type:Individual
Prefix:DR
First Name:KURTIS
Middle Name:LAMAR
Last Name:SAUDER
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 1:108 COMMUNITY DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-9505
Mailing Address - Country:US
Mailing Address - Phone:540-609-2300
Mailing Address - Fax:540-932-2059
Practice Address - Street 1:108 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:WAYNESBORO
Practice Address - State:VA
Practice Address - Zip Code:22980-9505
Practice Address - Country:US
Practice Address - Phone:540-949-0118
Practice Address - Fax:540-949-8903
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054135208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA437748OtherANTHEM
VA6736696OtherVIRGINIA PREMIER
VA6736696OtherSENTARA
VA6736696Medicaid
VA6736696Medicaid
VA6736696OtherVIRGINIA PREMIER