Provider Demographics
NPI:1306018866
Name:SANDEL CENTER FOR FACIAL PLASTIC SURGERY LLC
Entity Type:Organization
Organization Name:SANDEL CENTER FOR FACIAL PLASTIC SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:SANDEL
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:317-581-9385
Mailing Address - Street 1:127 LUBRANO DRIVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7559
Mailing Address - Country:US
Mailing Address - Phone:317-581-9385
Mailing Address - Fax:
Practice Address - Street 1:127 LUBRANO DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7559
Practice Address - Country:US
Practice Address - Phone:317-581-9385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0067391207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic SurgeryGroup - Single Specialty