Provider Demographics
NPI:1700843182
Name:SANDY, J STEPHEN (MD)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:STEPHEN
Last Name:SANDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 BELLEFONTAINE AVE
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-2800
Mailing Address - Country:US
Mailing Address - Phone:419-998-4575
Mailing Address - Fax:419-998-4586
Practice Address - Street 1:1001 BELLEFONTAINE AVE
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-2800
Practice Address - Country:US
Practice Address - Phone:419-998-4575
Practice Address - Fax:419-998-4586
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35038271207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000206138OtherANTHEM
OH03884OtherPARAMOUNT
OH080164657OtherRAILROAD MEDICARE
OH0344667Medicaid
OH727648OtherBUCKEYE
OH0344667Medicaid
OH727648OtherBUCKEYE
SA0411503Medicare PIN