Provider Demographics
NPI:1295942621
Name:KHAVARI, SARAH G (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:G
Last Name:KHAVARI
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 1:5100 SPRINGFIELD ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45431-1261
Mailing Address - Country:US
Mailing Address - Phone:937-259-9900
Mailing Address - Fax:937-259-9999
Practice Address - Street 1:68 DARST RD
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45440-3442
Practice Address - Country:US
Practice Address - Phone:937-458-6700
Practice Address - Fax:937-458-6736
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2009-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-090665207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2843230Medicaid
OH2843230Medicaid