Provider Demographics
NPI:1477525970
Name:SANDWELL, STEPHEN E (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:E
Last Name:SANDWELL
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 1:201 GOVERNORS DR SW FL 1
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-5171
Mailing Address - Country:US
Mailing Address - Phone:256-533-1600
Mailing Address - Fax:565-390-8562
Practice Address - Street 1:201 GOVERNORS DR SW FL 1
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801
Practice Address - Country:US
Practice Address - Phone:256-533-1600
Practice Address - Fax:256-539-0856
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2018-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA722363AS0400X
390200000X
NY281802-1207T00000X
AL37118207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL216388Medicaid
KY970028451OtherRR MCARE
AL216728Medicaid
KY000000243993OtherBCBS PIN #
AL216493Medicaid
KY9500292900Medicaid