Healthcare Provider Details

I. General information

NPI: 1811133473
Provider Name (Legal Business Name): SARAH J LANNUM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 01/13/2025
Certification Date: 01/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 10TH AVE DEPT OF EMERGENCY MEDICINE
NEW YORK NY
10019-1147
US

IV. Provider business mailing address

5820 OWENS DR
PLEASANTON CA
94588-3900
US

V. Phone/Fax

Practice location:
  • Phone: 212-523-8158
  • Fax:
Mailing address:
  • Phone: 925-737-3798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA105754
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: