Provider Demographics
NPI:1245084201
Name:BIRDSALL, SARA ELIZABETH (MD)
Entity type:Individual
Prefix:MRS
First Name:SARA
Middle Name:ELIZABETH
Last Name:BIRDSALL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:SARA
Other - Middle Name:ELIZABETH
Other - Last Name:MORAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:106 BARBARA LN
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-9175
Mailing Address - Country:US
Mailing Address - Phone:985-607-8511
Mailing Address - Fax:
Practice Address - Street 1:1514 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70121-2483
Practice Address - Country:US
Practice Address - Phone:594-842-3260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program