Healthcare Provider Details

I. General information

NPI: 1235668757
Provider Name (Legal Business Name): SARAH L MAXWELL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 06/24/2020
Certification Date: 06/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 16TH ST
SAN FRANCISCO CA
94158-2545
US

IV. Provider business mailing address

550 16TH STREET, BOX 0110
SAN FRANCISCO CA
94158-2545
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-2067
  • Fax:
Mailing address:
  • Phone: 415-502-2067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP03973
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: