Provider Demographics
NPI:1518259431
Name:ESPINO, SASA-GRAE M (MD)
Entity Type:Individual
Prefix:
First Name:SASA-GRAE
Middle Name:M
Last Name:ESPINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8580 MAGELLAN PKWY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-1149
Mailing Address - Country:US
Mailing Address - Phone:804-520-6730
Mailing Address - Fax:804-520-6731
Practice Address - Street 1:210 MEDICAL PARK BLVD STE 275
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-9348
Practice Address - Country:US
Practice Address - Phone:804-765-5905
Practice Address - Fax:804-765-5925
Is Sole Proprietor?:No
Enumeration Date:2011-05-11
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA101262899208600000X, 2086X0206X
IL0361404702086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery