Provider Demographics
NPI:1437187036
Name:LOYCHIK, SANDRA GRAY (MD)
Entity type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:GRAY
Last Name:LOYCHIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 12TH AVE STE B3
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3100
Mailing Address - Country:US
Mailing Address - Phone:814-940-7340
Mailing Address - Fax:814-940-1940
Practice Address - Street 1:1701 12TH AVE STE B3
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3100
Practice Address - Country:US
Practice Address - Phone:814-940-7340
Practice Address - Fax:814-940-1940
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD022958E2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0006672540016Medicaid
PAB37240Medicare UPIN
PA122192RRFMedicare ID - Type Unspecified