Provider Demographics
NPI:1922093442
Name:LEIVY, SANDER W (MD)
Entity Type:Individual
Prefix:
First Name:SANDER
Middle Name:W
Last Name:LEIVY
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 1:2766 ELECTRIC RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-3583
Mailing Address - Country:US
Mailing Address - Phone:540-989-6516
Mailing Address - Fax:540-989-5730
Practice Address - Street 1:2766 ELECTRIC RD
Practice Address - Street 2:SUITE A
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24018-3583
Practice Address - Country:US
Practice Address - Phone:540-989-6516
Practice Address - Fax:540-989-5730
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049415207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00V642R65Medicare ID - Type Unspecified
P00086779Medicare PIN
VAF54847Medicare UPIN