Provider Demographics
NPI:1659323939
Name:TIMERMAN, SANDRA ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ELIZABETH
Last Name:TIMERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:ELIZABETH
Other - Last Name:CRANE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:513 WASHINGTON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4073
Mailing Address - Country:US
Mailing Address - Phone:315-788-2211
Mailing Address - Fax:315-788-0956
Practice Address - Street 1:513 WASHINGTON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4073
Practice Address - Country:US
Practice Address - Phone:315-788-2211
Practice Address - Fax:315-788-0956
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2011-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY234066-1208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02654722Medicaid