Provider Demographics
NPI:1083971097
Name:GEFFERT, SARA WASHBURN FULLER (MD, MS, M(ASCP))
Entity Type:Individual
Prefix:MRS
First Name:SARA
Middle Name:WASHBURN FULLER
Last Name:GEFFERT
Suffix:
Gender:F
Credentials:MD, MS, M(ASCP)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 SUMMIT AVENUE
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4923
Mailing Address - Country:US
Mailing Address - Phone:401-793-7152
Mailing Address - Fax:401-793-7737
Practice Address - Street 1:593 EDDY ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-4923
Practice Address - Country:US
Practice Address - Phone:401-793-4020
Practice Address - Fax:401-793-7401
Is Sole Proprietor?:No
Enumeration Date:2012-04-15
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16823207RI0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program