MEDICARE: RALPH S SANDO JR. MD

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	207W00000X	Ophthalmology Physician	MD-072773L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	048653	OTHER	OR	BLUE CROSS
2	2011356000	OTHER	PA	INDEPENDENCE BLUE CROSS

General Provider Information

NPI Number	:	1326015421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH S SANDO JR. MD

Provider Business Mailing Address
First Line	:	100 CHURCH RD
Second Line	:
City	:	ARDMORE
State	:	PA
Zip	:	19003-2316
Country	:	US
Telephone Number	:	610-649-7616
Fax Number	:	610-649-6146

Provider Business Practice Location Address
First Line	:	100 CHURCH RD
Second Line	:
City	:	ARDMORE
State	:	PA
Zip	:	19003-2316
Country	:	US
Telephone Number	:	610-649-7616
Fax Number	:	610-649-6146

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	09/18/2012

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