Provider Demographics
NPI:1396962445
Name:ROSENFELD-O'TOOL, SANDRA ROSANNA (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:ROSANNA
Last Name:ROSENFELD-O'TOOL
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 1:800 BRADBURY DR SE STE 116
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4310
Mailing Address - Country:US
Mailing Address - Phone:505-272-1476
Mailing Address - Fax:
Practice Address - Street 1:2400 TUCKER NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-1009
Practice Address - Country:US
Practice Address - Phone:505-272-1734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036113944207Q00000X
IA32995207Q00000X
NMMD2018-0740207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1238353OtherCSA #
IA13238OtherMEDICARE PART B GROUP
IA16-1801OtherFQHC GROUP UGS
IA16D0387805OtherCLIA
IA31319OtherBC/BS IA INDIVIDUAL
IL421060724002Medicaid
IA13238OtherBC/BS IA GROUP
IA71503OtherWELLMARK BCBS
IA0080200Medicaid
IA71503OtherWELLMARK BCBS
IA13238OtherBC/BS IA GROUP
IA71503OtherWELLMARK BCBS
ILH24501Medicare UPIN