Provider Demographics
NPI:1336551365
Name:MANGUM NEEDHAM, SARAH ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:ROSE
Last Name:MANGUM NEEDHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:ROSE
Other - Last Name:MANGUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:709 CHESAPEAKE PL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-6236
Mailing Address - Country:US
Mailing Address - Phone:252-227-3191
Mailing Address - Fax:
Practice Address - Street 1:709 CHESAPEAKE PL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-6236
Practice Address - Country:US
Practice Address - Phone:252-227-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-26
Last Update Date:2014-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC36386208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics