Healthcare Provider Details

I. General information

NPI: 1033465695
Provider Name (Legal Business Name): KRISTIAN LASZLO SANDOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1314 BEDFORD AVE
PIKESVILLE MD
21208
US

IV. Provider business mailing address

3119 ROBERTS LNDG
FINKSBURG MD
21048-1352
US

V. Phone/Fax

Practice location:
  • Phone: 610-400-4253
  • Fax:
Mailing address:
  • Phone: 610-400-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMT202981
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD78799
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD0078799
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: