Provider Demographics
NPI:1063516656
Name:SANDE, JANE ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:ELIZABETH
Last Name:SANDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 FOX RD STE 201
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2492
Practice Address - Country:US
Practice Address - Phone:419-232-2323
Practice Address - Fax:419-232-2322
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD19982208000000X
DCMD0377502080P0207X
AL247132080P0207X
OH35078507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009995210Medicaid
AL009995220Medicaid
36986Medicare UPIN