Healthcare Provider Details

I. General information

NPI: 1558536789
Provider Name (Legal Business Name): CAROLINE SANCHEZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 02/02/2021
Certification Date: 02/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 PROSPERITY AVE SUITE 200
FAIRFAX VA
22031-4357
US

IV. Provider business mailing address

2710 PROSPERITY AVENUE SUITE 200
FAIRFAX VA
20902-4053
US

V. Phone/Fax

Practice location:
  • Phone: 703-280-2841
  • Fax: 703-650-2322
Mailing address:
  • Phone: 703-280-2841
  • Fax: 703-650-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD038282
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101251494
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberD72793
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberD72793
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberMD038282
License Number StateDC
# 6
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101251494
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: