Provider Demographics
NPI:1194799908
Name:BEALL, SANDRA C (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:C
Last Name:BEALL
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-3034
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:780 BROAD ST
Practice Address - Street 2:STE 4
Practice Address - City:MONTOURSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17754-2419
Practice Address - Country:US
Practice Address - Phone:570-368-2870
Practice Address - Fax:570-368-4463
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2020-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD036579E208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001057545Medicaid
C33961Medicare UPIN