Healthcare Provider Details

I. General information

NPI: 1215361449
Provider Name (Legal Business Name): MATTHEW SANDRIDGE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2013
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 E CLAY ST
RICHMOND VA
23298-5071
US

IV. Provider business mailing address

PO BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-0996
  • Fax: 804-828-0648
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number0102203890
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number1215361449
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: