Provider Demographics
NPI:1952385809
Name:KING, SANDRA M
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:M
Last Name:KING
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:SANDRA
Other - Middle Name:M
Other - Last Name:ABDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1310 NEW SALEM RD
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28110-9696
Mailing Address - Country:US
Mailing Address - Phone:704-242-0036
Mailing Address - Fax:
Practice Address - Street 1:1310 NEW SALEM RD
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28110-9696
Practice Address - Country:US
Practice Address - Phone:704-242-0036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC22879207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCN22879Medicaid
NC7910030Medicaid
NC7910030Medicaid
NC204352AMedicare ID - Type Unspecified
SCC825454632Medicare ID - Type Unspecified