Provider Demographics
NPI:1639332950
Name:SANDERS, HEATHER ANN (MD)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:SANDERS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:SANDERS
Other - Last Name:DICAPRIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-3226
Mailing Address - Country:US
Mailing Address - Phone:603-332-5211
Mailing Address - Fax:
Practice Address - Street 1:245 ROCHESTER HILL RD
Practice Address - Street 2:UNIT 2
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1775
Practice Address - Country:US
Practice Address - Phone:603-332-0238
Practice Address - Fax:603-332-7098
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH35-095852208000000X
NH15324208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3071983Medicaid
OHSA4299341Medicare PIN