Healthcare Provider Details

I. General information

NPI: 1568801314
Provider Name (Legal Business Name): KAITLIN MARIA SANZONE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2013
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 FARROW RD
COLUMBIA SC
29203-3220
US

IV. Provider business mailing address

7901 FARROW RD BRYAN PSYCHIATRIC HOSPITAL- FORENSIC
COLUMBIA SC
29203
US

V. Phone/Fax

Practice location:
  • Phone: 803-935-6586
  • Fax:
Mailing address:
  • Phone: 803-935-0505
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35834
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: