Provider Demographics
NPI:1447285648
Name:DAVIS, SANDIE VAUGH (PA)
Entity type:Individual
Prefix:
First Name:SANDIE
Middle Name:VAUGH
Last Name:DAVIS
Suffix:
Gender:F
Credentials:PA
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 1780
Mailing Address - Street 2:DIMENSIONS HEALTH CORPORATION
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-0780
Mailing Address - Country:US
Mailing Address - Phone:800-777-2455
Mailing Address - Fax:610-617-6280
Practice Address - Street 1:15001 HEALTH CENTER DRIVE
Practice Address - Street 2:BOWIE HEALTH CENTER
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716
Practice Address - Country:US
Practice Address - Phone:301-262-6150
Practice Address - Fax:610-617-6280
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0000459363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
S43128Medicare UPIN
MD007016Medicare ID - Type Unspecified