Provider Demographics
NPI:1659375327
Name:CHIN, SANDY (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:CHIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MEMBERS WAY
Mailing Address - Street 2:SUITE 402
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820
Mailing Address - Country:US
Mailing Address - Phone:603-742-1444
Mailing Address - Fax:603-742-1443
Practice Address - Street 1:10 MEMBERS WAY
Practice Address - Street 2:SUITE 402
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820
Practice Address - Country:US
Practice Address - Phone:603-742-1444
Practice Address - Fax:603-742-1443
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1014509208800000X
NH14314208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTI15215Medicare UPIN
CT340000365Medicare ID - Type Unspecified