Healthcare Provider Details

I. General information

NPI: 1316922388
Provider Name (Legal Business Name): MARTHA REY SAUNDERS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 HUGUENOT RD
MIDLOTHIAN VA
23113-2618
US

IV. Provider business mailing address

1407 HUGUENOT RD
MIDLOTHIAN VA
23113-2618
US

V. Phone/Fax

Practice location:
  • Phone: 804-794-2299
  • Fax: 804-794-5774
Mailing address:
  • Phone: 804-794-2299
  • Fax: 804-794-5774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101029927
License Number StateVA

VII. Legacy identifiers

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

# 1
Identifier81987
Identifier TypeOTHER
Identifier StateVA
Identifier IssuerALLIANCE
# 2
Identifier559424
Identifier TypeOTHER
Identifier StateVA
Identifier IssuerAETNA
# 3
Identifier81987
Identifier TypeOTHER
Identifier StateVA
Identifier IssuerMAMSI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: