MEDICARE: SANDRA C. TRUEBE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	12058	NH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AA1997	OTHER	NH	HPHC
2	468780	OTHER	NH	TUFTS
3	437892	OTHER	NH	CIGNA
4	3539084	OTHER	NH	CIGNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	30447Y	OTHER	NH	ANTHEM REFERRING RAN

General Provider Information

NPI Number	:	1508856956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA C. TRUEBE MD

Provider Business Mailing Address
First Line	:	275 MAMMOTH RD
Second Line	:	SUITE 2
City	:	MANCHESTER
State	:	NH
Zip	:	03109-4133
Country	:	US
Telephone Number	:	603-663-8300
Fax Number	:	603-663-8349

Provider Business Practice Location Address
First Line	:	275 MAMMOTH RD
Second Line	:	SUITE 2
City	:	MANCHESTER
State	:	NH
Zip	:	03109-4133
Country	:	US
Telephone Number	:	603-663-8300
Fax Number	:	603-663-8349

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	07/09/2007

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Directions to “ SANDRA C. TRUEBE MD” Practice Location

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