Basic Information
| Provider Information | |||||||||
| NPI: | 1407086812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SANDRIAN | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | TIDEY | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 PENNS WAY | ||||||||
| Address2: | SUITE 412 | ||||||||
| City: | NEW CASTLE | ||||||||
| State: | DE | ||||||||
| PostalCode: | 19720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026522455 | ||||||||
| FaxNumber: | 3023226251 | ||||||||
| Practice Location | |||||||||
| Address1: | 27 MARROWS RD | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197133701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024550900 | ||||||||
| FaxNumber: | 3027384706 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2009 | ||||||||
| LastUpdateDate: | 04/05/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | C2-0010488 | DE | Y | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | C2-0010488 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | C2-0010488 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.