Provider Demographics
NPI:1780660563
Name:RUPP, SARA J (MD)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:J
Last Name:RUPP
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 1:1451 GREEN HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-7492
Mailing Address - Country:US
Mailing Address - Phone:615-587-1628
Mailing Address - Fax:
Practice Address - Street 1:1451 GREEN HILL BLVD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-7492
Practice Address - Country:US
Practice Address - Phone:615-587-1628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000321782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA526817693AMedicaid
NYBB5295Medicare PIN
TN3002724Medicare PIN
GA526817693AMedicaid