Provider Demographics
NPI:1629280631
Name:SANDERS, KEITH LADSEN (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:LADSEN
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6830 MIDDLEFIELD TERRACE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744
Mailing Address - Country:US
Mailing Address - Phone:301-630-8825
Mailing Address - Fax:301-630-8825
Practice Address - Street 1:6830 MIDDLEFIELD TERRACE
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744
Practice Address - Country:US
Practice Address - Phone:301-630-8825
Practice Address - Fax:301-630-8825
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0036670208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery