Healthcare Provider Details

I. General information

NPI: 1386639664
Provider Name (Legal Business Name): JUAN A. SANCHEZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2005
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3407 WILKENS AVE SUITE 400
BALTIMORE MD
21229-5072
US

IV. Provider business mailing address

3407 WILKENS AVE SUITE 400
BALTIMORE MD
21229-5072
US

V. Phone/Fax

Practice location:
  • Phone: 410-368-2730
  • Fax: 410-951-4007
Mailing address:
  • Phone: 410-368-2730
  • Fax: 410-951-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD75512
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberD75512
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: