Individual
MRS. SARAH DONNELLY BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
593 EDDY ST, CLAVERICK 2, PROVIDENCE, RI 02903-4923
(401) 444-5120
(401) 444-4307
Mailing address
PO BOX 9484, PROVIDENCE, RI 02940-9484
(401) 854-2501
(401) 453-9619
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
2179
MA
363A00000X
Physician Assistant
Primary
PA00415
RI
Other
Enumeration date
09/20/2006
Last updated
09/12/2008
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