Provider Demographics
NPI:1003903956
Name:CASE, SARA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:ANN
Last Name:CASE
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 1:62 OLD FORGE HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BANTAM
Mailing Address - State:CT
Mailing Address - Zip Code:06750-1315
Mailing Address - Country:US
Mailing Address - Phone:860-567-8460
Mailing Address - Fax:860-567-8460
Practice Address - Street 1:62 OLD FORGE HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BANTAM
Practice Address - State:CT
Practice Address - Zip Code:06750-1315
Practice Address - Country:US
Practice Address - Phone:860-567-8460
Practice Address - Fax:860-567-8460
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT027169208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP00759522OtherMEDICARE RAILROAD
CT001271691Medicaid
1003903956OtherNPI NUMBER
CT1003903956Medicaid
CTD400003952Medicare PIN
CT1003903956Medicaid
CT020001211Medicare PIN