Provider Demographics
NPI:1609858943
Name:FOOTE, SANDRA C (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:C
Last Name:FOOTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:FOOTE
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:310 MULLET RUN
Mailing Address - Street 2:PO BOX 1186
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-5371
Mailing Address - Country:US
Mailing Address - Phone:302-422-4056
Mailing Address - Fax:302-422-4156
Practice Address - Street 1:310 MULLET RUN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5371
Practice Address - Country:US
Practice Address - Phone:302-422-4056
Practice Address - Fax:302-422-4156
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000080702Medicaid
G02136S01Medicare PIN