Provider Demographics
NPI:1841228707
Name:SANDFORT, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:SANDFORT
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 1:200 MILL RD
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5252
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:101 PAGE ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-3464
Practice Address - Country:US
Practice Address - Phone:508-973-5130
Practice Address - Fax:508-973-5135
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA58007208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ06317OtherBLUE CROSS BLUE SHIELD
058007OtherTUFTS
000000021262OtherBMC
0027845OtherNHP
MAB20915202OtherCIGNA
MA3020860Medicaid
3428634OtherAETNA
8226OtherHPHC
1202178003OtherCIGNA FOR REFERRALS
1401000OtherUHC
201129OtherBLUE CHIP
000334OtherSWH
020013712OtherRAILROAD MED
J06317OtherMASS BS
RIMS07821Medicaid
J06317OtherMASS BS
058007OtherTUFTS
MAJ06317Medicare PIN