MEDICARE: SARAH BOURGIN DO

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	207V00000X	Obstetrics & Gynecology Physician	W4063	TX
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558002238
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH BOURGIN DO

Provider Business Mailing Address
First Line	:	1301 W 38TH ST STE 600
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-1000
Country	:	US
Telephone Number	:	512-324-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 BARD AVENUE
Second Line	:	DEPARTMENT OF MEDICINE VILLA BLDG 1ST FLOOR
City	:	STATEN ISLAND
State	:	NY
Zip	:	10310-1664
Country	:	US
Telephone Number	:	718-818-2419
Fax Number	:

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

Provider Enumeration Date	:	04/05/2022
Last Update Date	:	04/13/2026

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