Basic Information
| Provider Information | |||||||||
| NPI: | 1922058650 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SANCHEZ | ||||||||
| FirstName: | CORAZON | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 CRAIGTOWN RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | PORT DEPOSIT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219041801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106429172 | ||||||||
| FaxNumber: | 8776357186 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 CRAIGTOWN RD STE 101 | ||||||||
| Address2: | |||||||||
| City: | PORT DEPOSIT | ||||||||
| State: | MD | ||||||||
| PostalCode: | 219041801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106429172 | ||||||||
| FaxNumber: | 4106429176 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 01/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | D0056807 | MD | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 722001400 | 05 | MD | MEDICAID |