MEDICARE: MRS. SARA JEANNE MCDOLE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	2080A0000X	Pediatric Adolescent Medicine Physician	PA01233	RI

General Provider Information

NPI Number	:	1306462502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARA JEANNE MCDOLE PA-C

Provider Business Mailing Address
First Line	:	225 CENTRAL ST
Second Line	:
City	:	HARRISVILLE
State	:	RI
Zip	:	02830-1536
Country	:	US
Telephone Number	:	401-263-1829
Fax Number	:

Provider Business Practice Location Address
First Line	:	234 MAPLE AVE
Second Line	:
City	:	BARRINGTON
State	:	RI
Zip	:	02806-3406
Country	:	US
Telephone Number	:	401-247-1644
Fax Number	:	401-247-4961

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2020
Last Update Date	:	03/30/2023

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