Healthcare Provider Details

I. General information

NPI: 1174968564
Provider Name (Legal Business Name): SARAH M MAINES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 06/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST
LEXINGTON KY
40536-0001
US

IV. Provider business mailing address

10511 LAGRANGE ROAD
LOUISVILLE KY
40223
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberR3263
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License Number50342
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: