Provider Demographics
NPI:1013984988
Name:ROBERTS, SARA P (PA)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:P
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:ME
Mailing Address - Zip Code:04937-3314
Mailing Address - Country:US
Mailing Address - Phone:207-861-5559
Mailing Address - Fax:207-861-5082
Practice Address - Street 1:4 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:ME
Practice Address - Zip Code:04937-3314
Practice Address - Country:US
Practice Address - Phone:207-861-5559
Practice Address - Fax:207-861-5082
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA876363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432678499Medicaid
MEP00239561Medicare PIN
MEAP2398Medicare PIN
ME432678499Medicaid