Provider Demographics
NPI:1841263670
Name:KALTREIDER, SARA ALICE (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:ALICE
Last Name:KALTREIDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:630 PETER JEFFERSON PKWY
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-8605
Mailing Address - Country:US
Mailing Address - Phone:434-244-8610
Mailing Address - Fax:434-244-8611
Practice Address - Street 1:630 PETER JEFFERSON PKWY
Practice Address - Street 2:SUITE 140
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-8605
Practice Address - Country:US
Practice Address - Phone:434-244-8610
Practice Address - Fax:434-244-8611
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101033508207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA66360OtherCOMMUNITY HEALTH
VA195459OtherANTHEM SERVICES
VAP00435219OtherMEDICARE PIN
VA195459OtherANTHEM HEALTHKEEPERS
VA436847OtherSOUTHERN HEALTH
VA66360OtherOPTIMA
VA1480129OtherCIGNA
VA00X074O01Medicare PIN
VA436847OtherSOUTHERN HEALTH