Provider Demographics
NPI:1508997446
Name:CONNOLLY, SARA (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CONNOLLY
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 1:50 ALCONA AVE
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-2201
Mailing Address - Country:US
Mailing Address - Phone:716-228-2485
Mailing Address - Fax:
Practice Address - Street 1:127 NORTH ST
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1631
Practice Address - Country:US
Practice Address - Phone:585-343-6030
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY239246207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY070412000093OtherFIDELIS CARE NY
NY3914317OtherINDEPENDENT HEALTH
NY00028035601OtherUNIVERA HEALTHCARE
NY000529196001OtherBLUE CROSS
NY02860557Medicaid
NY00028035601OtherUNIVERA HEALTHCARE