Provider Demographics
NPI:1922058650
Name:SANCHEZ, CORAZON (MD)
Entity Type:Individual
Prefix:
First Name:CORAZON
Middle Name:
Last Name:SANCHEZ
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 1:20 CRAIGTOWN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:PORT DEPOSIT
Mailing Address - State:MD
Mailing Address - Zip Code:21904-1801
Mailing Address - Country:US
Mailing Address - Phone:410-642-9172
Mailing Address - Fax:877-635-7186
Practice Address - Street 1:20 CRAIGTOWN RD STE 101
Practice Address - Street 2:
Practice Address - City:PORT DEPOSIT
Practice Address - State:MD
Practice Address - Zip Code:21904-1801
Practice Address - Country:US
Practice Address - Phone:410-642-9172
Practice Address - Fax:410-642-9176
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0056807208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD722001400Medicaid
MDH47541Medicare UPIN