Provider Demographics
NPI:1306011267
Name:SANDERSON, VINCENT R (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:R
Last Name:SANDERSON
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 1:499 DWYER WAY
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-3518
Mailing Address - Country:US
Mailing Address - Phone:724-342-3575
Mailing Address - Fax:
Practice Address - Street 1:499 DWYER WAY
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:PA
Practice Address - Zip Code:16146-3518
Practice Address - Country:US
Practice Address - Phone:724-342-3575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA010617E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAB33122Medicare UPIN