Healthcare Provider Details

I. General information

NPI: 1093967077
Provider Name (Legal Business Name): SANDRA V. KRISTIANSEN, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2008
Last Update Date: 10/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

176 E MAIN ST SUITE 4
WESTBOROUGH MA
01581-1763
US

IV. Provider business mailing address

7 REED AVE
WESTBOROUGH MA
01581-3643
US

V. Phone/Fax

Practice location:
  • Phone: 508-870-5900
  • Fax: 508-870-5960
Mailing address:
  • Phone: 508-870-5900
  • Fax: 508-870-5960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number75153
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number75153
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number75153
License Number StateMA

VIII. Authorized Official

Name: DR. SANDRA V. KRISTIANSEN
Title or Position: PRESIDENT / PHYSICIAN
Credential: MD.
Phone: 508-870-5900