Provider Demographics
NPI:1437129525
Name:SANDRIN, MAYTE L (MD)
Entity Type:Individual
Prefix:DR
First Name:MAYTE
Middle Name:L
Last Name:SANDRIN
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:PO BOX 743070
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3070
Mailing Address - Country:US
Mailing Address - Phone:864-560-4304
Mailing Address - Fax:864-560-4413
Practice Address - Street 1:853 N CHURCH ST
Practice Address - Street 2:SUITE 720
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-3098
Practice Address - Country:US
Practice Address - Phone:864-560-6419
Practice Address - Fax:864-560-7498
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27758207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAA08776067OtherMEDICARE PIN
SCAA08775193OtherMEDICARE PIN
SC277587Medicaid
NC5902164Medicaid
SCAA08773365OtherMEDICARE PIN
SCE4390OtherMEDCOST
SCAA08775019OtherMEDICARE PIN
SCAA08776066OtherMEDICARE PIN
SCSC3018J577OtherMEDICARE PIN
SC7750747OtherAETNA
SCAA08773365OtherMEDICARE PIN
SCAA08776066OtherMEDICARE PIN
SCAA08776067OtherMEDICARE PIN
NC5902164Medicaid
SCAA0877Medicare PIN
SCAA08775193Medicare PIN