Provider Demographics
NPI:1982883054
Name:SANDRA C. FOOTE MD LLC
Entity Type:Organization
Organization Name:SANDRA C. FOOTE MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:C
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:302-422-4056
Mailing Address - Street 1:PO BOX 1186
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19963-5086
Mailing Address - Country:US
Mailing Address - Phone:302-422-4056
Mailing Address - Fax:302-422-4156
Practice Address - Street 1:310 MULLET RUN
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-5371
Practice Address - Country:US
Practice Address - Phone:302-422-4056
Practice Address - Fax:302-422-4156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000080702Medicaid
DE0000080702Medicaid