Healthcare Provider Details

I. General information

NPI: 1699760637
Provider Name (Legal Business Name): SANDRA M. CIFOR DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2005
Last Update Date: 01/22/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7008 AUGUSTA NATIONAL
FAYETTEVILLE PA
17222-9418
US

IV. Provider business mailing address

7008 AUGUSTA NATIONAL
FAYETTEVILLE PA
17222-9418
US

V. Phone/Fax

Practice location:
  • Phone: 301-730-4212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberH39929
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberOS007769L
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS007769L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: