Provider Demographics
NPI:1952737884
Name:MAC, SARA REGEZI (CRNP)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:REGEZI
Last Name:MAC
Suffix:
Gender:F
Credentials:CRNP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10110 MOLECULAR DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-7539
Mailing Address - Country:US
Mailing Address - Phone:301-279-2779
Mailing Address - Fax:240-403-0190
Practice Address - Street 1:10110 MOLECULAR DR
Practice Address - Street 2:SUITE 206
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-7539
Practice Address - Country:US
Practice Address - Phone:301-279-2779
Practice Address - Fax:240-403-0190
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2018-01-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR202979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD697440600Medicaid