Provider Demographics
NPI:1598170763
Name:ATALLAH, SARA
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ATALLAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 WEST 24TH STREET
Mailing Address - Street 2:SUITE 402
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-2667
Mailing Address - Country:US
Mailing Address - Phone:814-453-6687
Mailing Address - Fax:814-456-4676
Practice Address - Street 1:311 WEST 24TH STREET
Practice Address - Street 2:SUITE 402
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-2667
Practice Address - Country:US
Practice Address - Phone:814-453-6687
Practice Address - Fax:814-456-4676
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD469843207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology