1366506065 NPI number — DR. SARAH L BARON MD

Table of content: DR. SARAH L BARON MD (NPI 1366506065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366506065 NPI number — DR. SARAH L BARON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARON
Provider First Name:
SARAH
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366506065
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27608
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87125-7608
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-771-1089
Provider Business Mailing Address Fax Number:
505-771-2581

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
700 HIGH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87102-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-242-4444
Provider Business Practice Location Address Fax Number:
505-242-3820
Provider Enumeration Date:
12/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  97188 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: A3477 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 611484600 . This is a "DEPARTMENT OF ENERGY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 201032593 . This is a "POES HEALTH PLAN" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 560137 . This is a "ARIZONA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM019289 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 787002596 . This is a "DUNS FOR INDIAN HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: PROVP11783 . This is a "MOLINA HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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