Healthcare Provider Details

I. General information

NPI: 1720253339
Provider Name (Legal Business Name): SARA KOENIG MD, MBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DARRINGTON DR
CARY NC
27513-8134
US

IV. Provider business mailing address

211 WATERSIDE DR
CARRBORO NC
27510-1288
US

V. Phone/Fax

Practice location:
  • Phone: 919-338-5620
  • Fax:
Mailing address:
  • Phone: 505-377-5406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZB0001X
TaxonomyBlood Banking & Transfusion Medicine Physician
License Number2009-00706
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License Number2009-00706
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number2009-00706
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: