Provider Demographics
NPI:1770523466
Name:CHUA, SARA (DO)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CHUA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:
Other - Last Name:CHUA-DILLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1 AMALIA DR
Mailing Address - Street 2:
Mailing Address - City:BUCKHANNON
Mailing Address - State:WV
Mailing Address - Zip Code:26201-2239
Mailing Address - Country:US
Mailing Address - Phone:304-473-2305
Mailing Address - Fax:304-473-2314
Practice Address - Street 1:1 AMALIA DR
Practice Address - Street 2:
Practice Address - City:BUCKHANNON
Practice Address - State:WV
Practice Address - Zip Code:26201-2239
Practice Address - Country:US
Practice Address - Phone:304-473-2305
Practice Address - Fax:304-473-2314
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV1812166000Medicaid
WV1812166000Medicaid
WVWV1264AMedicare PIN
WV2029282Medicare PIN
WV2029284Medicare PIN
WV7369375OtherAETNA
WV2029283Medicare PIN
WVH61674Medicare UPIN
WV1812166000Medicaid