Provider Demographics
NPI:1528022951
Name:FORTNA, SANDRA JANE (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:JANE
Last Name:FORTNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1803 MOUNT ROSE AVE
Mailing Address - Street 2:SUITE B3
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3026
Mailing Address - Country:US
Mailing Address - Phone:717-851-1405
Mailing Address - Fax:717-851-3712
Practice Address - Street 1:1001 S GEORGE ST
Practice Address - Street 2:MKB 4TH FLR
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3676
Practice Address - Country:US
Practice Address - Phone:717-851-2417
Practice Address - Fax:717-851-3712
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD043028L207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00025768502OtherUNIVERA
OH0940183Medicaid
PA1770316OtherAETNA
PA733398OtherBLUE SHIELD
PA001406477Medicaid
WV1071715OtherWEST VIRGINIA WORKERS COMP
PA268092OtherUNISON-WMG
PA1039836OtherGATEWAY
MD949364OtherCAREFIRST MD BCBS
PA20089138OtherAMERIHEALTH MERCY-WMG
PA210777OtherUNISON
PA313005OtherUPMC
PAP00440841OtherRR MEDICARE
PAP00853360Medicare PIN
PAP00440841OtherRR MEDICARE
PA268092OtherUNISON-WMG
PA001406477Medicaid