Provider Demographics
NPI:1497732242
Name:HOLLENSEAD, SANDRA C (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:HOLLENSEAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:C
Other - Last Name:HALE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 967
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0967
Mailing Address - Country:US
Mailing Address - Phone:502-852-1648
Mailing Address - Fax:502-852-2046
Practice Address - Street 1:530 S. JACKSON ST.
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-852-6395
Practice Address - Fax:502-852-1761
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY23394207ZH0000X, 207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200079790Medicaid
KY64-879497OtherMEDICAID
KY0285227Medicare ID - Type Unspecified
KYE03674Medicare UPIN