Provider Demographics
NPI:1659960920
Name:LAUTERBACH, SARA (PA-C)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:LAUTERBACH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ATWELL RD
Mailing Address - Street 2:
Mailing Address - City:COOPERSTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13326-1301
Mailing Address - Country:US
Mailing Address - Phone:518-234-3450
Mailing Address - Fax:518-234-3415
Practice Address - Street 1:136 PARKWAY DR
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-5150
Practice Address - Country:US
Practice Address - Phone:518-234-3450
Practice Address - Fax:518-234-3415
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY027443363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant