Provider Demographics
NPI:1770642142
Name:CARDENAS VILLA, SANDRA MARIA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:MARIA
Last Name:CARDENAS VILLA
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 1:419 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-3613
Mailing Address - Country:US
Mailing Address - Phone:978-996-1374
Mailing Address - Fax:
Practice Address - Street 1:50 PROSPECT ST
Practice Address - Street 2:SUITE 401
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01841-2841
Practice Address - Country:US
Practice Address - Phone:978-683-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2146835Medicaid
1770642142OtherFALLON
510492088OtherUHC
AA101504OtherHPHC
MAJ42674OtherBCBS
1770642142OtherBMC
496793OtherTUFTS
6687413OtherCIGNA
95686502OtherNETWORK
95686502OtherNETWORK