NPIMap

Individual provider Active NPI

Marie Sandoval, MD

  • Internal Medicine Physician
  • South Burlington, VT
National Provider Identifier
1982612313
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
0420009692 Issued in VT
Practice address
1 Timber LN
South Burlington, VT 05403-7205
Phone
(802) 847-4714
Fax
(802) 847-6333
NPI assigned
Aug 3, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 0420009692 VT Primary

Addresses

Primary practice location

1 Timber LN
South Burlington, VT 05403-7205

Mailing address

10 Weathersfield Bow
Essex Junction, VT 05452-2645
Phone (802) 878-8515

Other identifiers 1

IdentifierTypeStateIssuer
0VN1761MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081107000022 VT Practitioner - Internal Medicine 9335208248 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Wisconsin School of Medicine, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1 S Prospect St
Burlington, VT 05401-3456
Phone (802) 847-0000

111 Colchester Ave
Burlington, VT 05401-1473
Phone (802) 847-0000

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0420009692VTMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Vermont Medical Center Inc Internal Medicine CurrentSince Jul 1, 1998 Accepting new patients
Fletcher Allen Health Care Inc Past Accepting new patients

Locations

1 S Prospect St
Burlington, VT 05401
Phone (802) 847-4531

1 Timber Ln
South Burlington, VT 05403
Phone (802) 658-4714

Interoperability endpoints

  • Direct secure messaging: msandoval3885@direct.uvmhealth.org

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1154563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1982612313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 WEATHERSFIELD BOW",
            "city": "ESSEX JUNCTION",
            "state": "VT",
            "postal_code": "054522645",
            "telephone_number": "802-878-8515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 TIMBER LN",
            "city": "SOUTH BURLINGTON",
            "state": "VT",
            "postal_code": "054037205",
            "telephone_number": "802-847-4714",
            "fax_number": "802-847-6333"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SANDOVAL",
        "first_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-03",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "VT",
            "license": "0420009692",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0VN1761",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Burlington, VT

Sources for this page

Verify at the official NPI Registry.