Provider Demographics
NPI:1700817608
Name:MCDONALD, SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:MCDONALD
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:BOX 647
Mailing Address - Street 2:601 ELMWOOD AVE.
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-486-0600
Mailing Address - Fax:585-486-0649
Practice Address - Street 1:125 RED CREEK DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-4272
Practice Address - Country:US
Practice Address - Phone:585-486-0600
Practice Address - Fax:585-486-0649
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1766312085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA920006593OtherPALMETTO GBA-RAILROAD MC
NYP010176631OtherBLUE SHIELD
NY7836338OtherAETNA
GA920007534OtherPALMETTO GBA-RAILROAD MC
NYP010176631OtherBLUE CHOICE
NYP020176631OtherBLUE SHIELD
NY01552845Medicaid
NY101266FEOtherPREFERRED CARE
NY01552845Medicaid
NYDD0395Medicare PIN
NYP010176631OtherBLUE SHIELD