Provider Demographics
NPI:1760682413
Name:PLUMMER, SARAH TYLER (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:TYLER
Last Name:PLUMMER
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 1:5515 S ROXBORO ST
Mailing Address - Street 2:#24
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7241
Mailing Address - Country:US
Mailing Address - Phone:919-699-2411
Mailing Address - Fax:
Practice Address - Street 1:5515 S ROXBORO ST
Practice Address - Street 2:#24
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7241
Practice Address - Country:US
Practice Address - Phone:919-699-2411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-20
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT188885T208000000X
PAMD436553208000000X
NCMT1738382080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics