Provider Demographics
NPI:1023087954
Name:CHOUINARD, SARAH B (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:B
Last Name:CHOUINARD
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 1:122 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:CLAY
Mailing Address - State:WV
Mailing Address - Zip Code:25043-7046
Mailing Address - Country:US
Mailing Address - Phone:304-587-7301
Mailing Address - Fax:304-587-2594
Practice Address - Street 1:122 CENTER ST
Practice Address - Street 2:
Practice Address - City:CLAY
Practice Address - State:WV
Practice Address - Zip Code:25043-7046
Practice Address - Country:US
Practice Address - Phone:304-587-7301
Practice Address - Fax:304-587-2594
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV19770207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001720361OtherMS BCBS
WV1841746000Medicaid
WV7111252OtherAETNA
WV001720361OtherMS BCBS
WVH18354Medicare UPIN
WV2027784Medicare PIN
WV2027781Medicare PIN
WV2027783Medicare PIN
WV7111252OtherAETNA