Provider Demographics
NPI:1134515018
Name:WAGSTAFF, SARAH ANNE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ANNE
Last Name:WAGSTAFF
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 MASSACHUSETTS AVE NW
Mailing Address - Street 2:MCCABE HALL
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-8036
Mailing Address - Country:US
Mailing Address - Phone:202-885-3380
Mailing Address - Fax:202-885-1222
Practice Address - Street 1:4400 MASSACHUSETTS AVE NW
Practice Address - Street 2:MCCABE HALL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-8036
Practice Address - Country:US
Practice Address - Phone:202-885-3380
Practice Address - Fax:202-885-1222
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004897363A00000X
DCPA031540363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant