Provider Demographics
NPI:1275534299
Name:SONDERGAARD, SALLY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SALLY
Middle Name:ELIZABETH
Last Name:SONDERGAARD
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:23 CROSSROADS DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5420
Mailing Address - Country:US
Mailing Address - Phone:410-581-9200
Mailing Address - Fax:410-581-9203
Practice Address - Street 1:23 CROSSROADS DR
Practice Address - Street 2:SUITE 220
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5420
Practice Address - Country:US
Practice Address - Phone:410-581-9200
Practice Address - Fax:410-581-9203
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2011-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0027136207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD811500100Medicaid
MD811500100Medicaid
B70083Medicare UPIN