Provider Demographics
NPI:1972549343
Name:LOOBY-GORDON, SANDRA S (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:S
Last Name:LOOBY-GORDON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:960 MASSACHUSETTS AVE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 MASSACHUSETTS AVE, SUITE 6C
Practice Address - Street 2:CROSSTOWN BLDG
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2605
Practice Address - Country:US
Practice Address - Phone:617-414-5951
Practice Address - Fax:617-414-9201
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-11-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA727622083A0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110050735AMedicaid
MA3086763Medicaid
MAJ10341Medicare ID - Type Unspecified
MA110050735AMedicaid
MA3086763Medicaid