MEDICARE: SANDRA V. KRISTIANSEN, MD, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	75153	MA
2	207RR0500X	Rheumatology Physician	75153	MA
3	202K00000X	Phlebology Physician	75153	MA

General Provider Information

NPI Number	:	1093967077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SANDRA V. KRISTIANSEN, MD, PC

Provider Business Mailing Address
First Line	:	7 REED AVE
Second Line	:
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-3643
Country	:	US
Telephone Number	:	508-870-5900
Fax Number	:	508-870-5960

Provider Business Practice Location Address
First Line	:	176 E MAIN ST
Second Line	:	SUITE 4
City	:	WESTBOROUGH
State	:	MA
Zip	:	01581-1763
Country	:	US
Telephone Number	:	508-870-5900
Fax Number	:	508-870-5960

Authorized Official
Title or Position	:	PRESIDENT / PHYSICIAN
Name	:	DR. SANDRA V. KRISTIANSEN
Credential	:	MD.
Telephone Number	:	508-870-5900

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	10/21/2008

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