Provider Demographics
NPI:1245495365
Name:SANDY, NATASHA AGNES (MD)
Entity type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:AGNES
Last Name:SANDY
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 1:2710 GOODWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2109
Mailing Address - Country:US
Mailing Address - Phone:410-696-7553
Mailing Address - Fax:
Practice Address - Street 1:8890 CENTRE PARK DRIVE
Practice Address - Street 2:SUITE 300B
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2104
Practice Address - Country:US
Practice Address - Phone:410-696-7553
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-29
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0071050207N00000X, 207Q00000X
NY263711207N00000X, 207Q00000X
NJ25MA08428600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD0071050OtherMARYLAND LICENSE
NY263711OtherNY LIC
NJ25MA08428600OtherLICENCSE