Provider Demographics
NPI:1851438782
Name:SANDOVAL-MARTINEZ, CARLOS R (MD)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:R
Last Name:SANDOVAL-MARTINEZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:46 WALNUT BOTTOM RD STE 100
Practice Address - Street 2:
Practice Address - City:SHIPPENSBURG
Practice Address - State:PA
Practice Address - Zip Code:17257-8219
Practice Address - Country:US
Practice Address - Phone:717-477-2764
Practice Address - Fax:717-217-4207
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD430665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101888092Medicaid
PA25-1716306OtherMULTIPLAN/PHCS
PAMD430665OtherLICENSE
PASA1959170OtherHIGHMARK BLUESHIELD
PA1021776OtherFIRST HEALTH
PA120420400OtherDEPT OF LABOR
PA25-1716306OtherSOUTH CENTRAL PREFERRED
PAG920-0058OtherCAREFIRST
PA527319OtherHEALTH AMERICA
PA867633OtherMEDICARE GROUP #
PAP008714OtherGATEWAY
PA50070714OtherCAPITAL BLUECROSS (VMG)
PA50086067OtherCAPITAL BLUECROSS (TFP)
PA5542600OtherAETNA NON-HMO
PA1007307260034OtherMEDICAID GROUP #
PA1018880920001Medicaid
PA219268OtherUNISON
PA25-1716306OtherDEVON
PA25-1716306OtherINTERGROUP
PA25-1716306OtherGREATWEST HEALTHCARE
PAFS0207490OtherDEA
PA2166239OtherMAMSI
PA25-1716306OtherINFORMED
PA25-1716306OtherHEALTHNET/TRICARE
PAP00404187OtherRAILROAD MEDICARE
PA25-1716306OtherMULTIPLAN/PHCS
PA110654LN7Medicare PIN