Provider Demographics
NPI:1689693053
Name:SANDERS, ROBERT EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EDWARD
Last Name:SANDERS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8981 NORWIN AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2746
Mailing Address - Country:US
Mailing Address - Phone:724-864-3030
Mailing Address - Fax:724-864-3032
Practice Address - Street 1:8981 NORWIN AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:N HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2746
Practice Address - Country:US
Practice Address - Phone:724-864-3030
Practice Address - Fax:724-864-3032
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD020923E207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0007345530001Medicaid
PAC31812Medicare UPIN
PA147011Medicare PIN