Provider Demographics
NPI:1952417511
Name:GOLDSBERRY, SARA HELEN (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:HELEN
Last Name:GOLDSBERRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5400 DUPONT CIRCLE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-2770
Mailing Address - Country:US
Mailing Address - Phone:513-576-7700
Mailing Address - Fax:513-576-1020
Practice Address - Street 1:14 NORTH SECOND STREET
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:OH
Practice Address - Zip Code:45167-1101
Practice Address - Country:US
Practice Address - Phone:937-392-4381
Practice Address - Fax:937-392-4383
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2012-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35076420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2246046Medicaid
OHPO0422160OtherRAIL ROAD MEDICARE
IN200873970Medicaid
OHGO4216701Medicare PIN
OH2246046Medicaid