Provider Demographics
NPI:1386806966
Name:SANDER, LAURA D (MD, MPH)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:D
Last Name:SANDER
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 FLATBUSH AVE STE C5
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-3782
Mailing Address - Country:US
Mailing Address - Phone:800-336-1100
Mailing Address - Fax:
Practice Address - Street 1:1259 BEDFORD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-1813
Practice Address - Country:US
Practice Address - Phone:800-336-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2024-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD72551207R00000X
DCMD045055207R00000X
NJ25MA11719100207R00000X
NY316137207RA0000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RA0000XAllopathic & Osteopathic PhysiciansInternal MedicineAdolescent Medicine