Provider Demographics
NPI:1437165776
Name:SULLIVAN, SARA R (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:R
Last Name:SULLIVAN
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 1:3905 SACRAMENTO ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1636
Mailing Address - Country:US
Mailing Address - Phone:415-752-8038
Mailing Address - Fax:415-752-8099
Practice Address - Street 1:3905 SACRAMENTO ST
Practice Address - Street 2:SUITE 301
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1636
Practice Address - Country:US
Practice Address - Phone:415-752-8038
Practice Address - Fax:415-752-8099
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA108759208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8840504Medicaid
PA001900621Medicaid
NJ8840504Medicaid
PA057084Medicare ID - Type Unspecified