Provider Demographics
NPI:1508881681
Name:SANDERSON, STEVEN L (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:L
Last Name:SANDERSON
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 1:212 29TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-1084
Mailing Address - Country:US
Mailing Address - Phone:828-326-0658
Mailing Address - Fax:828-326-7105
Practice Address - Street 1:212 29TH AVE NE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-1084
Practice Address - Country:US
Practice Address - Phone:828-326-0621
Practice Address - Fax:828-326-7105
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9900343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89127FTMedicaid
NCH00092OtherUPIN
NC127FTOtherNC BCBS
NC9900343OtherNC LICENSE
NC9900343OtherNC LICENSE
NC127FTOtherNC BCBS
NC9900343OtherNC LICENSE
NC2279602FMedicare Oscar/Certification
NC2279602EMedicare PIN