Provider Demographics
NPI:1851495063
Name:ROBERT G SANFORD MD ALAN D ROUMM MD AND RAVI D ACHARYA MD PTR
Entity Type:Organization
Organization Name:ROBERT G SANFORD MD ALAN D ROUMM MD AND RAVI D ACHARYA MD PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:SANFORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-761-3505
Mailing Address - Street 1:1845 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1703
Mailing Address - Country:US
Mailing Address - Phone:717-761-3507
Mailing Address - Fax:
Practice Address - Street 1:1845 CENTER ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-1703
Practice Address - Country:US
Practice Address - Phone:717-761-3507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3350OtherGEISINGER
PA02312300OtherKEYSTONE SR BLUE
PA314576OtherHEALTH AMERICA
PADD8455OtherTRAVELERS MEDICARE
PA7094822OtherGATEWAY
PA02312300OtherKEYSTONE
PA02312300OtherCAPITAL BLUE CROSS
PA094822OtherPA BLUE SHIELD
PA7094822OtherGATEWAY
PA=========OtherPEBTF
PA=========OtherPRIME SOURCE
PA02312300OtherKEYSTONE SR BLUE
PA094822Medicare ID - Type Unspecified