Provider Demographics
NPI:1548220288
Name:GIBSON, SANDY M (MD)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:M
Last Name:GIBSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2201 E MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-7071
Mailing Address - Country:US
Mailing Address - Phone:804-643-3061
Mailing Address - Fax:804-643-3817
Practice Address - Street 1:2201 E MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-7071
Practice Address - Country:US
Practice Address - Phone:804-643-3061
Practice Address - Fax:804-643-3817
Is Sole Proprietor?:No
Enumeration Date:2006-03-25
Last Update Date:2008-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101041677207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E27285Medicare UPIN