Provider Demographics
NPI:1891097002
Name:BROWN, SARAH LUPO
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:LUPO
Last Name:BROWN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 YORK ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:ME
Mailing Address - Zip Code:03909-1314
Mailing Address - Country:US
Mailing Address - Phone:207-363-4870
Mailing Address - Fax:
Practice Address - Street 1:124 YORK ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:ME
Practice Address - Zip Code:03909-1314
Practice Address - Country:US
Practice Address - Phone:207-363-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOT190174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist