Provider Demographics
NPI:1104146935
Name:SANDERS, CLARA (MD)
Entity type:Individual
Prefix:
First Name:CLARA
Middle Name:
Last Name:SANDERS
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 1:21 JOHN ST
Mailing Address - Street 2:#1
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02459-2347
Mailing Address - Country:US
Mailing Address - Phone:978-516-8876
Mailing Address - Fax:
Practice Address - Street 1:21 JOHN ST
Practice Address - Street 2:#1
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02459-2347
Practice Address - Country:US
Practice Address - Phone:978-516-8876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-03
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP02000208000000X
MA257186207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics