Healthcare Provider Details

I. General information

NPI: 1912245242
Provider Name (Legal Business Name): NATASHA SANDY MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2013
Last Update Date: 01/22/2020
Certification Date: 01/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8890 CENTRE PARK DR STE 300B
COLUMBIA MD
21045-2188
US

IV. Provider business mailing address

2710 GOODWOOD RD
BALTIMORE MD
21214-2109
US

V. Phone/Fax

Practice location:
  • Phone: 410-696-7553
  • Fax: 410-696-7510
Mailing address:
  • Phone: 443-255-7089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number StateMD

VIII. Authorized Official

Name: NATASHA A. SANDY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 443-255-7089