Provider Demographics
NPI:1003846213
Name:LOOT, SARAH OSORIO (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:OSORIO
Last Name:LOOT
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 1:101 SCHOOL STREET
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:WV
Mailing Address - Zip Code:25901
Mailing Address - Country:US
Mailing Address - Phone:304-469-2582
Mailing Address - Fax:304-469-2584
Practice Address - Street 1:101 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:OAK HILL
Practice Address - State:WV
Practice Address - Zip Code:25901
Practice Address - Country:US
Practice Address - Phone:304-469-2582
Practice Address - Fax:304-469-2584
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV11589208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0110418000Medicaid
WVL00600063Medicare ID - Type Unspecified
WV0110418000Medicaid