Provider Demographics
NPI:1689686313
Name:ABBRUZZI, SARA A (DO)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:A
Last Name:ABBRUZZI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8500-6335
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-6335
Mailing Address - Country:US
Mailing Address - Phone:215-807-8000
Mailing Address - Fax:215-807-8345
Practice Address - Street 1:5000 FRANKFORD AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19124-2620
Practice Address - Country:US
Practice Address - Phone:215-331-2405
Practice Address - Fax:215-331-8521
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS012350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1021731200003Medicaid
PA2294733000OtherIBC
PA1616702OtherHIGHMARK BLUE SHIELD
PA3012444OtherKEYSTONE FIRST
PA1616702OtherHIGHMARK BS
PA2294733000OtherKEYSTONE IBC
PA2294733000OtherIBC
PA081174GH2Medicare PIN
PA1021731200003Medicaid