Individual
MS. SARA ELIZABETH DOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
1415 PORTLAND AVE, DEPARTMENT OF SURGERY, ROCHESTER, NY 14621-3038
(585) 922-4715
Mailing address
100 KINGS HWY S, ROCHESTER, NY 14617-5504
(585) 922-0553
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03587446
—
NY
01
—
4942206
AETNA/RCIPA
NY
Enumeration date
05/11/2012
Last updated
02/08/2019
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