MEDICARE: DR. SARA TIEGREEN PH.D.

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	103TC0700X	Clinical Psychologist	4056	NC

General Provider Information

NPI Number	:	1366745069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA TIEGREEN PH.D.

Provider Business Mailing Address
First Line	:	508 FULTON ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-3875
Country	:	US
Telephone Number	:	919-899-6259
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 HAMMOND BUSINESS PL
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27603-3666
Country	:	US
Telephone Number	:	919-899-6259
Fax Number	:

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

Provider Enumeration Date	:	12/19/2010
Last Update Date	:	12/19/2010

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