Healthcare Provider Details

I. General information

NPI: 1689949935
Provider Name (Legal Business Name): SARA BARMETTLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2012
Last Update Date: 01/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

55 FRUIT ST
BOSTON MA
02114-2621
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-3850
  • Fax: 617-724-0239
Mailing address:
  • Phone: 617-726-3850
  • Fax: 617-724-0239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0201X
TaxonomyAllergy & Immunology (Internal Medicine) Physician
License Number267241
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: