Individual
SANDRA S BAUCOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1809 S CHURCH ST STE 302, SMITHFIELD, VA 23430-1861
(757) 780-8400
(757) 432-3279
Mailing address
1809 S CHURCH ST STE 302, SMITHFIELD, VA 23430-1861
(757) 780-8400
(757) 432-3279
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101043663
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006706631
—
VA
Enumeration date
05/10/2006
Last updated
06/02/2021
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