Provider Demographics
NPI:1780643437
Name:SUBAK-KRAH, SARAH E
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:SUBAK-KRAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:E
Other - Last Name:SUBAK-SHARPE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:100 FODEN ROAD WEST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-828-0361
Mailing Address - Fax:207-874-1483
Practice Address - Street 1:84 MARGINAL WAY
Practice Address - Street 2:SUITE 800
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2443
Practice Address - Country:US
Practice Address - Phone:207-774-5816
Practice Address - Fax:207-523-8597
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME016301207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
048603OtherANTHEM
3230812OtherAETNA
MEMX9178Medicare PIN
H97192Medicare UPIN
ME0230Medicare ID - Type Unspecified
ME296020099Medicare ID - Type Unspecified