Provider Demographics
NPI:1083630438
Name:BUCHANAN, SARA (MED)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:BUCHANAN
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:667 WATERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EAST PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02914-1712
Mailing Address - Country:US
Mailing Address - Phone:401-438-9500
Mailing Address - Fax:
Practice Address - Street 1:667 WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:EAST PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02914-1712
Practice Address - Country:US
Practice Address - Phone:401-438-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI292177OtherEI BLUE CROSS
RIES01788Medicaid
RI2092OtherEI NHPRC
RI412296OtherEI BLUE CHIP
RI6400144OtherEI UHP