Provider Demographics
NPI:1215552674
Name:JOHNSON, SARAH (DO)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:502 STEVENS AVE UNIT 1B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04103-2611
Mailing Address - Country:US
Mailing Address - Phone:207-894-4806
Mailing Address - Fax:207-517-2371
Practice Address - Street 1:502 STEVENS AVE UNIT 1B
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-2611
Practice Address - Country:US
Practice Address - Phone:207-894-4806
Practice Address - Fax:207-517-2371
Is Sole Proprietor?:No
Enumeration Date:2020-06-11
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3584207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine