Provider Demographics
NPI:1619946738
Name:SANDERS, JASON B (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:B
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1132 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1039
Mailing Address - Country:US
Mailing Address - Phone:336-369-7100
Mailing Address - Fax:336-369-7101
Practice Address - Street 1:1132 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1039
Practice Address - Country:US
Practice Address - Phone:336-369-7100
Practice Address - Fax:336-369-7101
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC 2005-00329174400000X
SCSC TL27619174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00230758OtherRAILROAD MEDICARE
NC5901630Medicaid
NC806691OtherCOMMUNITY EYE CARE
NCE333650310OtherMECOST
NC140NWOtherBCBS
NC7521438OtherAETNA
NY32567OtherCIGNA
NC2041481Medicare PIN
NC0264730005Medicare NSC
NC0264730001Medicare NSC
NY32567OtherCIGNA
SCAA09475874Medicare PIN