Active NPI
Timothy Alonzo Sanderson, M.D.
- Psychiatry Physician
- Norfolk, VA
National Provider Identifier
1821258989
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 0101033522
- Practice address
- 4101 Granby St
Suite 203
Norfolk, VA 23504-1117 - Phone
- (757) 622-5191
- NPI assigned
- Jun 12, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 0101033522 | VA | Primary |
Addresses
Primary practice location
4101 Granby St
Suite 203
Norfolk, VA 23504-1117
Mailing address
4101 Granby St
Suite 203
Norfolk, VA 23504-1117
Phone (757) 622-5191
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
- Opted out of Medicare
- Yes, effective Jun 25, 2014 through Jun 25, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0101033522 | VA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1213228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1213228800000",
"number": "1821258989",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4101 GRANBY ST",
"address_2": "SUITE 203",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235041117",
"telephone_number": "757-622-5191"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4101 GRANBY ST",
"address_2": "SUITE 203",
"city": "NORFOLK",
"state": "VA",
"postal_code": "235041117",
"telephone_number": "757-622-5191"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SANDERSON",
"first_name": "TIMOTHY",
"middle_name": "ALONZO",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-12",
"last_updated": "2008-06-12",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "VA",
"license": "0101033522",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Norfolk, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.