Provider Demographics
NPI:1477592582
Name:SANDROWICZ, RICHARD R (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:R
Last Name:SANDROWICZ
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 1:1265 WAYNE AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3501
Mailing Address - Country:US
Mailing Address - Phone:724-349-6742
Mailing Address - Fax:724-349-1213
Practice Address - Street 1:1265 WAYNE AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3501
Practice Address - Country:US
Practice Address - Phone:724-349-6742
Practice Address - Fax:724-349-1213
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD025422E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000949341-0001Medicaid
PA251586963OtherUPMC
PASA165137OtherBLUE CROSS BLUE SHIELD
PA251586963OtherGATEWAY ASSURED
PA251586963OtherUPMC FOR LIFE
PA251586963OtherAAG
PA251586963OtherUNITED HEALTH CARE
PA165137OtherINDEPENDENT BLUE
PAP001589OtherGATEWAY
PASA1491452OtherHIGHMARK
PA165137OtherINDEPENDENT BLUE
PA000949341-0001Medicaid