Healthcare Provider Details

I. General information

NPI: 1033192406
Provider Name (Legal Business Name): SANFORD HOLLAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 03/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

746 JEFFERSON AVE
SCRANTON PA
18510-1624
US

IV. Provider business mailing address

3998 FAIR RIDGE DR STE 300
FAIRFAX VA
22033-2907
US

V. Phone/Fax

Practice location:
  • Phone: 570-348-7100
  • Fax:
Mailing address:
  • Phone: 703-295-9360
  • Fax: 703-766-9725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD021902E
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier0973857
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier0009738570010
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
IdentifierP00141017
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerRR MEDICARE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: