Provider Demographics
NPI:1942279807
Name:SANDLIN, JESSE LEE (MD)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:LEE
Last Name:SANDLIN
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 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2500
Mailing Address - Fax:717-339-2502
Practice Address - Street 1:18 DEATRICK DR
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-6958
Practice Address - Country:US
Practice Address - Phone:717-339-2500
Practice Address - Fax:717-339-2502
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061153A207X00000X
VA0101244584207X00000X
TN46817207X00000X
PAMD460512207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1942279807Medicaid
TN1521937Medicare PIN
IN000000377481OtherANTHEM
IN1119001Medicare PIN
VA1942279807OtherBCBS
TN1521937Medicaid
IN200527280Medicaid
TN1124048541OtherGROUP NPI
H16679Medicare UPIN
TN0839170001Medicare NSC
TN1942279807OtherNPI
TN4291627OtherBLUECROSS BLUESHIELD
TN3719301Medicare PIN