Provider Demographics
NPI:1831185297
Name:SANFORD, KATHRYN ANNE (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:ANNE
Last Name:SANFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ANNE
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:330 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4465
Mailing Address - Country:US
Mailing Address - Phone:937-435-1445
Mailing Address - Fax:937-439-7552
Practice Address - Street 1:330 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45459-4465
Practice Address - Country:US
Practice Address - Phone:937-435-1445
Practice Address - Fax:937-439-7552
Is Sole Proprietor?:No
Enumeration Date:2005-09-21
Last Update Date:2013-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.070854207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0280673Medicaid
OH0280673Medicaid
G38521Medicare UPIN
OHH082540Medicare PIN