Provider Demographics
NPI:1245201243
Name:KELLEY, SARAH (DO)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:KELLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 WEATHERWOOD LANE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-2746
Mailing Address - Country:US
Mailing Address - Phone:724-850-3150
Mailing Address - Fax:724-850-9139
Practice Address - Street 1:562 SHEARER ST
Practice Address - Street 2:SUITE 103
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-2746
Practice Address - Country:US
Practice Address - Phone:724-850-3150
Practice Address - Fax:724-850-9139
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012095207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1013710240001Medicaid
PA092189SY7Medicare ID - Type Unspecified
PAI32960Medicare UPIN