Provider Demographics
NPI:1376806851
Name:TIGGELAAR, SARAH MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MARIE
Last Name:TIGGELAAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 CLINTON AVE S
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14620-1448
Mailing Address - Country:US
Mailing Address - Phone:585-279-4800
Mailing Address - Fax:
Practice Address - Street 1:777 CLINTON AVE S
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14620-1448
Practice Address - Country:US
Practice Address - Phone:585-279-4800
Practice Address - Fax:585-442-8319
Is Sole Proprietor?:No
Enumeration Date:2012-06-20
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDMRM-1245207Q00000X
TN52517207Q00000X
NY319468207Q00000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09324064Medicaid
AR213308001Medicaid
MO1376806851Medicaid
TNQ018597Medicaid