Provider Demographics
NPI:1992838395
Name:BOTSTEIN, SANDRA M (MD)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:M
Last Name:BOTSTEIN
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 1:6710 FALCONBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27517-7878
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1801 FAYETTEVILLE ST
Practice Address - Street 2:OLD HEALTH BUILDING, STUDENT HEALTH AND COUNSELING SERV
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3129
Practice Address - Country:US
Practice Address - Phone:919-530-5229
Practice Address - Fax:919-530-7969
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC38065174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCF41914Medicare UPIN