Individual
MRS. CARMEN SANDRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
5401 OLD YORK RD STE 331, PHILADELPHIA, PA 19141-3045
(215) 456-8220
(215) 456-5820
Mailing address
101 E OLNEY AVE STE 400, PHILADELPHIA, PA 19120-2470
(215) 456-1825
(215) 456-5926
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
OS012640
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1378633
AETNA
PA
01
—
7298896
AETNA
PA
Enumeration date
10/10/2006
Last updated
02/11/2022
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