Provider Demographics
NPI:1285707125
Name:SANDBERG, DAVID ERIC (DPM)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:SANDBERG
Suffix:
Gender:M
Credentials:DPM
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 66
Mailing Address - Street 2:
Mailing Address - City:SOUTH DEERFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01373
Mailing Address - Country:US
Mailing Address - Phone:413-774-2928
Mailing Address - Fax:413-665-0584
Practice Address - Street 1:1 BURNHAM STREET
Practice Address - Street 2:
Practice Address - City:TURNERS FALLS
Practice Address - State:MA
Practice Address - Zip Code:01376
Practice Address - Country:US
Practice Address - Phone:413-774-2928
Practice Address - Fax:413-665-0584
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPD1799213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0362204Medicaid
MAY70816OtherBCBS
T58777Medicare UPIN
MA0362204Medicaid