Provider Demographics
NPI:1821258989
Name:SANDERSON, TIMOTHY ALONZO (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALONZO
Last Name:SANDERSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 GRANBY ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23504-1117
Mailing Address - Country:US
Mailing Address - Phone:757-622-5191
Mailing Address - Fax:
Practice Address - Street 1:4101 GRANBY ST
Practice Address - Street 2:SUITE 203
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23504-1117
Practice Address - Country:US
Practice Address - Phone:757-622-5191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010335222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry