Provider Demographics
NPI:1972595171
Name:FLEMING, SANDRA (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:FLEMING
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 LYONS ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-5599
Mailing Address - Country:US
Mailing Address - Phone:781-329-1400
Mailing Address - Fax:781-329-6479
Practice Address - Street 1:386 WASHINGTON ST STE 2
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-6218
Practice Address - Country:US
Practice Address - Phone:617-326-3232
Practice Address - Fax:781-329-6479
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA220999207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2066921Medicaid
MA2066921Medicaid
MAA3739602Medicare PIN