Provider Demographics
NPI:1336359199
Name:SANFORD, MELANIE BERNADETTE (MD)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:BERNADETTE
Last Name:SANFORD
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 1:1331N ELM ST 200
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-6304
Mailing Address - Country:US
Mailing Address - Phone:888-592-6045
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1331N ELM ST 200
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6304
Practice Address - Country:US
Practice Address - Phone:888-592-6045
Practice Address - Fax:336-482-2177
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2013-011692085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1336359199Medicaid
NC1336359199Medicaid