Provider Demographics
NPI:1043748056
Name:CULLETON, SARA POIRIER (MD, PHD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:POIRIER
Last Name:CULLETON
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:POIRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:355 W 16TH ST STE 4800
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2392
Practice Address - Country:US
Practice Address - Phone:317-963-7288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-03
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN11019312A390200000X
IN01085063A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11019312AOtherINDIANA PROFESSIONAL LICENSING AGENCY