Provider Demographics
NPI:1366439937
Name:SCROGGINS, SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:SCROGGINS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1003 NEW LOUDON RD
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-5003
Mailing Address - Country:US
Mailing Address - Phone:518-786-7723
Mailing Address - Fax:
Practice Address - Street 1:1003 LOUDEN
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-5003
Practice Address - Country:US
Practice Address - Phone:518-786-7723
Practice Address - Fax:518-786-7749
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-29
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY155439207RH0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B83065Medicare UPIN
CC3041Medicare PIN
820000367Medicare PIN