Provider Demographics
NPI:1619158896
Name:SANDEL, OLGA (PAC)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:SANDEL
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6824 OLD PIMLICO RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1614
Mailing Address - Country:US
Mailing Address - Phone:410-241-7811
Mailing Address - Fax:410-876-5330
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:443-849-7695
Practice Address - Fax:443-849-8826
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDC0003629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD098193100Medicaid