Provider Demographics
NPI:1396831491
Name:SANDBERG, M. CRAIG (MD)
Entity Type:Individual
Prefix:
First Name:M. CRAIG
Middle Name:
Last Name:SANDBERG
Suffix:
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 1:76 VETERANS AVE
Mailing Address - Street 2:BATH VA MEDICAL CENTER
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-0810
Mailing Address - Country:US
Mailing Address - Phone:607-664-4300
Mailing Address - Fax:607-664-4320
Practice Address - Street 1:76 VETERANS AVE
Practice Address - Street 2:BATH VA MEDICAL CENTER
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-0810
Practice Address - Country:US
Practice Address - Phone:607-664-4300
Practice Address - Fax:607-664-4320
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1993772084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
V70203Medicare ID - Type Unspecified
G36083Medicare UPIN
00336498Medicare ID - Type Unspecified