Provider Demographics
NPI: | 1831620129 |
---|---|
Name: | KLEIN, SARA ASHLEY (MD) |
Entity type: | Individual |
Prefix: | |
First Name: | SARA |
Middle Name: | ASHLEY |
Last Name: | KLEIN |
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: | PO BOX 936857 |
Mailing Address - Street 2: | |
Mailing Address - City: | ATLANTA |
Mailing Address - State: | GA |
Mailing Address - Zip Code: | 31193-6857 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 910-662-7500 |
Mailing Address - Fax: | 910-662-7501 |
Practice Address - Street 1: | 1509 DOCTORS CIR BLDG C |
Practice Address - Street 2: | |
Practice Address - City: | WILMINGTON |
Practice Address - State: | NC |
Practice Address - Zip Code: | 28401-7403 |
Practice Address - Country: | US |
Practice Address - Phone: | 910-662-7500 |
Practice Address - Fax: | 910-662-7501 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2017-03-27 |
Last Update Date: | 2022-10-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IL | 125070160 | 207R00000X |
IL | 125.070160 | 2084N0400X |
390200000X | ||
NC | 2022-02632 | 2084N0400X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | |
No | 390200000X | Student, Health Care | Student in an Organized Health Care Education/Training Program |