Provider Demographics
NPI:1912936873
Name:STASS, SANFORD A (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:A
Last Name:STASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 64592
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4592
Mailing Address - Country:US
Mailing Address - Phone:410-328-5555
Mailing Address - Fax:410-328-0929
Practice Address - Street 1:22 S GREENE ST
Practice Address - Street 2:NBW73
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1544
Practice Address - Country:US
Practice Address - Phone:410-328-5514
Practice Address - Fax:410-328-0929
Is Sole Proprietor?:No
Enumeration Date:2006-07-02
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045319207ZP0101X, 207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD220017394Medicare PIN
MDLK47Medicare PIN
MDCA9059Medicare PIN
MDE79369Medicare UPIN