Provider Demographics
NPI:1316928120
Name:EGLICK HARKAVY, SANDRA (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:
Last Name:EGLICK HARKAVY
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 1:1 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2007
Mailing Address - Country:US
Mailing Address - Phone:610-567-6964
Mailing Address - Fax:610-567-6170
Practice Address - Street 1:1500 LANSDOWNE AVE
Practice Address - Street 2:
Practice Address - City:DARBY
Practice Address - State:PA
Practice Address - Zip Code:19023-1200
Practice Address - Country:US
Practice Address - Phone:610-237-4544
Practice Address - Fax:610-567-5689
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD0214624207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA446456OtherBLUE SHIELD
PA0032614000OtherKEYSTONE HEALTH PLAN EAST
PA0009698270006Medicaid
PA4633540OtherAETNA PPO
PA845057OtherAETNA HMO
PA1098932OtherKEYSTONE MERCY
PA0032614000OtherKEYSTONE HEALTH PLAN EAST
PA446456OtherBLUE SHIELD