Provider Demographics
NPI:1770557209
Name:SANDIDGE, DONNA R (MD)
Entity type:Individual
Prefix:DR
First Name:DONNA
Middle Name:R
Last Name:SANDIDGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:310 TAUGHANNOCK BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-3251
Mailing Address - Country:US
Mailing Address - Phone:607-252-3590
Mailing Address - Fax:607-252-3592
Practice Address - Street 1:310 TAUGHANNOCK BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-3251
Practice Address - Country:US
Practice Address - Phone:607-252-3590
Practice Address - Fax:607-252-3592
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2016-01-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY220140207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02154516Medicaid
NY030004925OtherRR MEDICARE PIN
NYCC8362OtherRR MEDICARE GROUP
PA0018306520001Medicaid
NY02154516Medicaid
G23784Medicare UPIN