Provider Demographics
NPI:1780020289
Name:COULBOURN, SARA WOZNY (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:WOZNY
Last Name:COULBOURN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:WOZNY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:300 DORCHESTER AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2420
Mailing Address - Country:US
Mailing Address - Phone:410-228-2603
Mailing Address - Fax:410-901-6080
Practice Address - Street 1:300 DORCHESTER AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2420
Practice Address - Country:US
Practice Address - Phone:410-228-2603
Practice Address - Fax:410-901-6080
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-12
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT203656207Q00000X
MDD80826207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine