Provider Demographics
NPI:1477873792
Name:LA GRANGE, SARA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ANN
Last Name:LA GRANGE
Suffix:
Gender:
Credentials:MD
Other - Prefix:DR
Other - First Name:SARA
Other - Middle Name:ANN
Other - Last Name:LUDIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:960 MASSACHUSETTS AVENUE
Mailing Address - Street 2:FL 2
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2690
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 PEARL ST
Practice Address - Street 2:SUITE 2000
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301
Practice Address - Country:US
Practice Address - Phone:508-584-4104
Practice Address - Fax:508-584-4105
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA244868208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110114830AMedicaid