Provider Demographics
NPI:1992708796
Name:BERENS, SANFORD VICTOR (MD)
Entity type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:VICTOR
Last Name:BERENS
Suffix:
Gender:M
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:PO BOX 14416
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-1416
Mailing Address - Country:US
Mailing Address - Phone:912-355-8200
Mailing Address - Fax:912-356-6967
Practice Address - Street 1:6 WHEELER CT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5719
Practice Address - Country:US
Practice Address - Phone:912-355-8200
Practice Address - Fax:912-356-6967
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA131132085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00007532AMedicaid
GA027111OtherBLUE CROSS BLUE SHIELD
SC208502Medicaid
GA027111OtherBLUE CROSS BLUE SHIELD
GA00007532AMedicaid