Provider Demographics
NPI:1326015421
Name:SANDO, RALPH S JR (MD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:S
Last Name:SANDO
Suffix:JR
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 1:100 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2316
Mailing Address - Country:US
Mailing Address - Phone:610-649-7616
Mailing Address - Fax:610-649-6146
Practice Address - Street 1:100 CHURCH RD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2316
Practice Address - Country:US
Practice Address - Phone:610-649-7616
Practice Address - Fax:610-649-6146
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-072773L207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR048653OtherBLUE CROSS
PA2011356000OtherINDEPENDENCE BLUE CROSS
PA2011356000OtherINDEPENDENCE BLUE CROSS
PAH39303Medicare UPIN