Provider Demographics
NPI:1508856956
Name:TRUEBE, SANDRA C (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:TRUEBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:C
Other - Last Name:FARKOUH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:275 MAMMOTH RD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03109-4133
Mailing Address - Country:US
Mailing Address - Phone:603-663-8300
Mailing Address - Fax:603-663-8349
Practice Address - Street 1:275 MAMMOTH RD
Practice Address - Street 2:SUITE 2
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03109-4133
Practice Address - Country:US
Practice Address - Phone:603-663-8300
Practice Address - Fax:603-663-8349
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH12058208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHAA1997OtherHPHC
NH468780OtherTUFTS
NH437892OtherCIGNA
NH3539084OtherCIGNA
NH30203998Medicaid
NH30447YOtherANTHEM REFERRING RAN
NH3539084OtherCIGNA
NHAA1997OtherHPHC