Provider Demographics
NPI:1538108733
Name:KANE, SARAH JANE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JANE
Last Name:KANE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:JANE
Other - Last Name:MCCRACKEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1060 FIRST COLONIAL RD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3002
Mailing Address - Country:US
Mailing Address - Phone:757-395-2323
Mailing Address - Fax:757-395-6280
Practice Address - Street 1:1060 FIRST COLONIAL RD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-3002
Practice Address - Country:US
Practice Address - Phone:757-395-2323
Practice Address - Fax:757-395-6280
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001425363A00000X
VA0110006668363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
S118Medicare PIN
211878Medicare Oscar/Certification