Individual provider Active NPI

Kathleen Mary Sardegna, MD

  • Pediatrics Physician
  • Richmond, VA
National Provider Identifier
1407829021
Registry record updated Apr 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036630 Issued in CT
Practice address
2809 North Ave
Richmond, VA 23222-3647
Phone
(804) 525-1851
NPI assigned
Feb 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 036630 CT Primary

Addresses

Primary practice location

2809 North Ave
Richmond, VA 23222-3647

Mailing address

2809 North Ave
Richmond, VA 23222-3647

Other identifiers 4

IdentifierTypeStateIssuer
001366302MedicaidCT
004236007MedicaidCT
036630OtherCTPHYSICIAN SURGEON
26581OtherCTCONTROLLED SUBSTANCE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036630CTMDLicensed Practical Nurse

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1492214400000",
    "number": "1407829021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2809 NORTH AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232223647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2809 NORTH AVE",
            "city": "RICHMOND",
            "state": "VA",
            "postal_code": "232223647",
            "telephone_number": "804-525-1851"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SARDEGNA",
        "first_name": "KATHLEEN",
        "middle_name": "MARY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-02-13",
        "last_updated": "2017-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CT",
            "license": "036630",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001366302",
            "state": "CT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004236007",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN SURGEON",
            "identifier": "036630",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONTROLLED SUBSTANCE",
            "identifier": "26581",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richmond, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.