Provider Demographics
NPI:1578674354
Name:GILBERT-LORD, SANDRA CECILE (MS, PA-C)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:CECILE
Last Name:GILBERT-LORD
Suffix:
Gender:F
Credentials:MS, PA-C
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 1599
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04402-1599
Mailing Address - Country:US
Mailing Address - Phone:207-992-2601
Mailing Address - Fax:
Practice Address - Street 1:500 WALTER ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2534
Practice Address - Country:US
Practice Address - Phone:505-262-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA-827363A00000X
NMPZ2016-0037363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME408260099Medicaid
MEAP253501Medicare PIN
MEAP2535Medicare PIN