Provider Demographics
NPI:1609850114
Name:NEAL, SARA LYNN (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:LYNN
Last Name:NEAL
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 1:1125 N CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1007
Mailing Address - Country:US
Mailing Address - Phone:336-832-8035
Mailing Address - Fax:
Practice Address - Street 1:1125 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1007
Practice Address - Country:US
Practice Address - Phone:336-832-8035
Practice Address - Fax:336-832-8094
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600385207QS0010X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA10060818Medicaid
NC74518OtherMEDCOST
NC20667OtherPARTNERS
5023579OtherAETNA
NC8961932Medicaid
SCQ0038HMedicaid
WV3810010793Medicaid
NC61932OtherBCBS
NC20667OtherPARTNERS
NC2227014BMedicare PIN
80183731Medicare PIN