Basic Information
| Provider Information | |||||||||
| NPI: | 1972568814 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZIEVE | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | T. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 758963 | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212758963 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8048224355 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2300 E PARHAM RD | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232283118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8042702150 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 11/07/2007 | ||||||||
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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 | 0101029809 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5630959 | 05 | VA | MEDICAID |