Provider Demographics
NPI:1013169101
Name:GIORGI, SARA LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:SARA
Middle Name:LYNN
Last Name:GIORGI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 GENESEE ST
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-6214
Mailing Address - Country:US
Mailing Address - Phone:315-798-9788
Mailing Address - Fax:315-798-9766
Practice Address - Street 1:2405 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6214
Practice Address - Country:US
Practice Address - Phone:315-798-9788
Practice Address - Fax:315-798-9766
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY256424-1207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03217796Medicaid
NY12095842OtherCAQH
NY12095842OtherCAQH