Provider Demographics
NPI:1669462214
Name:SANDBERG, WARREN STON (MD PHD)
Entity type:Individual
Prefix:DR
First Name:WARREN
Middle Name:STON
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:615-936-2000
Mailing Address - Fax:
Practice Address - Street 1:1211 21ST AVE SOUTH
Practice Address - Street 2:MEDICAL ARTS BLDG., ROOM 701
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-1050
Practice Address - Country:US
Practice Address - Phone:615-936-1595
Practice Address - Fax:615-343-7246
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA155981207L00000X
TN46027207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA790550OtherTUFTS HEALTH PLAN
MA3179524Medicaid
MAJ18935OtherBCBS MA
G70682Medicare UPIN
MA790550OtherTUFTS HEALTH PLAN