Provider Demographics
NPI:1922385459
Name:DEFOE, SARAHGENE (MD)
Entity Type:Individual
Prefix:
First Name:SARAHGENE
Middle Name:
Last Name:DEFOE
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 1:815 FREEPORT RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-3301
Mailing Address - Country:US
Mailing Address - Phone:412-784-4900
Mailing Address - Fax:412-784-4905
Practice Address - Street 1:815 FREEPORT RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15215-3301
Practice Address - Country:US
Practice Address - Phone:412-784-4900
Practice Address - Fax:412-784-4905
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4436292085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPENDINGMedicaid
NCPENDINGMedicaid