Provider Demographics
NPI:1912245242
Name:NATASHA SANDY MD PA
Entity Type:Organization
Organization Name:NATASHA SANDY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:SANDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-255-7089
Mailing Address - Street 1:2710 GOODWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2109
Mailing Address - Country:US
Mailing Address - Phone:443-255-7089
Mailing Address - Fax:
Practice Address - Street 1:8890 CENTRE PARK DR STE 300B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-2188
Practice Address - Country:US
Practice Address - Phone:410-696-7553
Practice Address - Fax:410-696-7510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD271236OtherMEDICARE