Provider Demographics
NPI:1376672808
Name:SANCHEZ, RICARDO L (MD, MPH)
Entity Type:Individual
Prefix:
First Name:RICARDO
Middle Name:L
Last Name:SANCHEZ
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BRAYTON POINT RD
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:MA
Mailing Address - Zip Code:02790-5117
Mailing Address - Country:US
Mailing Address - Phone:508-636-2747
Mailing Address - Fax:
Practice Address - Street 1:154 BRAYTON POINT RD
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:MA
Practice Address - Zip Code:02790-5117
Practice Address - Country:US
Practice Address - Phone:508-636-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038564207P00000X
NY201224-1207P00000X
RIMD12115207P00000X
MA60121207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007060807OtherMEDICARE PTAN
RI1376672Medicaid
RI007060807OtherMEDICARE PTAN