Provider Demographics
NPI:1952469629
Name:BULL, SARA CATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:CATHERINE
Last Name:BULL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60122
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0122
Mailing Address - Country:US
Mailing Address - Phone:704-373-0212
Mailing Address - Fax:704-347-5261
Practice Address - Street 1:530 1ST AVE STE 9V
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6402
Practice Address - Country:US
Practice Address - Phone:646-501-0197
Practice Address - Fax:704-347-5261
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY381379363LP0200X
NC2233492080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP1293Medicaid
NC7004313Medicaid
NJ0098337Medicaid
NC223349OtherNC LICENSE NUMBER
NC7004313Medicaid
NC2593385Medicare PIN
NJP24514Medicare UPIN