Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 01571 | MD |
Y | 222Z00000X | Podiatrist | 01571 | MD |
N | 213EP1101X | Primary Podiatric Medicine | E1-0000231 | DE |
N | 213ES0103X | Foot & Ankle Surgery | PO1000122 | DC |
NPI | 1063736569 |
---|---|
Provider Name | Chantel Nicole Sanford |
First Address | Pikesville, MD 21208-1351 |
Second Address | Pikesville, MD 21208-1351 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/03/2010 |
Last Update Date | 02/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3109344 | (05) | OH |
392852 | (02) | MD |