Provider Demographics
NPI:1922252345
Name:RUPPENTHAL, SARAH (PA-C)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:RUPPENTHAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:JO
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:805 FARSON ST STE 117
Practice Address - Street 2:
Practice Address - City:BELPRE
Practice Address - State:OH
Practice Address - Zip Code:45714-1000
Practice Address - Country:US
Practice Address - Phone:740-401-0033
Practice Address - Fax:740-401-0039
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.003365RX363A00000X
WV449363AM0700X
OH50.003365363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0070652Medicaid
WV449OtherWV BOARD OF OSTEOPATHY
WV01389OtherWV BOARD OF MEDICINE
OH0070652Medicaid
OHH015561Medicare PIN
WV449OtherWV BOARD OF OSTEOPATHY
WVPA32731Medicare PIN
OH0070652Medicaid
WVWV0878A655Medicare PIN