Provider Demographics
NPI:1770574071
Name:SANBORN, DANITA YOERGER (MD)
Entity type:Individual
Prefix:
First Name:DANITA
Middle Name:YOERGER
Last Name:SANBORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DANITA
Other - Middle Name:MARIE
Other - Last Name:YOERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIANS ORGANIZATION INC
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-726-1543
Mailing Address - Fax:617-726-7684
Practice Address - Street 1:55 FRUIT ST YAW 5
Practice Address - Street 2:CARDIAC UNIT ASSOCIATES
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-726-1543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA204957207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ24904OtherBCBS OF MA
MA204957OtherTUFTS HEALTH PLAN
MA0171905Medicaid
MAA34064Medicare ID - Type Unspecified
MA0171905Medicaid