Provider Demographics
NPI:1326026451
Name:SANDERS, KEVIN W (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 COLISEUM DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-5906
Mailing Address - Country:US
Mailing Address - Phone:757-452-3441
Mailing Address - Fax:757-224-1799
Practice Address - Street 1:4000 COLISEUM DR
Practice Address - Street 2:SUITE 300
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5906
Practice Address - Country:US
Practice Address - Phone:757-452-3441
Practice Address - Fax:757-224-1799
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101050661208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007502532Medicaid
VA55957OtherSENTARA HEALTHCARE
VA326593OtherANTHEM BC BS
VA340000621Medicare ID - Type Unspecified
VA55957OtherSENTARA HEALTHCARE
F77186Medicare UPIN