Provider Demographics
NPI:1629303540
Name:SANFORD CARDIOLOGY, PLLC
Entity Type:Organization
Organization Name:SANFORD CARDIOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RHANDAL
Authorized Official - Middle Name:N
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-295-5511
Mailing Address - Street 1:110 FIELDS DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-5072
Mailing Address - Country:US
Mailing Address - Phone:919-777-9005
Mailing Address - Fax:919-708-1550
Practice Address - Street 1:110 FIELDS DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-5072
Practice Address - Country:US
Practice Address - Phone:919-777-9005
Practice Address - Fax:919-708-1550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC123151207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902813Medicaid