Provider Demographics
NPI:1881253474
Name:BRASSARD, SARAH ANNE (DO)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:BRASSARD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4756 SPRINGVEW DR, APT 305
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16509
Mailing Address - Country:US
Mailing Address - Phone:774-272-2435
Mailing Address - Fax:
Practice Address - Street 1:5515 PEACH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16509-2603
Practice Address - Country:US
Practice Address - Phone:814-868-8294
Practice Address - Fax:814-868-8294
Is Sole Proprietor?:No
Enumeration Date:2019-06-07
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13483368-1204207R00000X
PAOT019225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOT019225OtherTRAINING LICENSE