Healthcare Provider Details

I. General information

NPI: 1770976524
Provider Name (Legal Business Name): SARAH LINN COROMANDEL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SARAH LINN MIFFLIN

II. Dates (important events)

Enumeration Date: 03/17/2015
Last Update Date: 07/15/2021
Certification Date: 07/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MATTHEW ST
MARIETTA OH
45750-1635
US

IV. Provider business mailing address

401 N EWING ST
LANCASTER OH
43130-3372
US

V. Phone/Fax

Practice location:
  • Phone: 740-376-1994
  • Fax: 740-374-7701
Mailing address:
  • Phone: 740-687-8651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberAP2282058A41
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number34.013585
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: