Provider Demographics
NPI:1487634564
Name:MEYERSON, SANDRA M (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:M
Last Name:MEYERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:M
Other - Last Name:HOENIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:330 BAKER AVE
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2129
Mailing Address - Country:US
Mailing Address - Phone:978-287-9400
Mailing Address - Fax:978-287-9408
Practice Address - Street 1:330 BAKER AVE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2129
Practice Address - Country:US
Practice Address - Phone:978-287-9400
Practice Address - Fax:978-287-9408
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA75416208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0016163OtherNEIGHBORHOOD HEALTH
MA1202087OtherUNITED HEALTHCARE
MA3098605Medicaid
MA20939OtherHARVARD PILGRIM
MA4228968OtherAETNA
MAB10207602OtherCIGNA
MAJ12317OtherBLUE CROSS
MA725270OtherTUFTS
MA4228968OtherAETNA
MAB10207602OtherCIGNA