Provider Demographics
NPI:1487656724
Name:SHUBERT, SARAH BETH (MD)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:BETH
Last Name:SHUBERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:SHUBERT
Other - Last Name:BANERJEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:C/O ST MARYS HEALTH SYSTEM - PROVIDER ENROLLMENT
Mailing Address - Street 2:PO BOX 7291
Mailing Address - City:LEWISTON
Mailing Address - State:ME
Mailing Address - Zip Code:04243-7291
Mailing Address - Country:US
Mailing Address - Phone:207-777-8950
Mailing Address - Fax:207-777-8800
Practice Address - Street 1:117 AUBURN ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-6003
Practice Address - Country:US
Practice Address - Phone:207-797-4791
Practice Address - Fax:207-317-5390
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME018045207X00000X
CAA90230207X00000X
TXM3461207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187028901Medicaid
TX0094NSOtherBCBS
TX8F5231Medicare PIN
TXI34987Medicare UPIN
TX187028901Medicaid