Provider Demographics
NPI:1831240944
Name:SANDERS, ERNEST LENWOOD JR (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:LENWOOD
Last Name:SANDERS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2949 NEW BERN AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-1248
Mailing Address - Country:US
Mailing Address - Phone:919-231-4454
Mailing Address - Fax:919-231-4456
Practice Address - Street 1:2949 NEW BERN AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-1248
Practice Address - Country:US
Practice Address - Phone:919-231-4454
Practice Address - Fax:919-231-4456
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC29659207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8974451Medicaid
NC74451OtherBLUE CROSS BLUE SHIELD
NC74451OtherBLUE CROSS BLUE SHIELD
NC8974451Medicaid