Healthcare Provider Details

I. General information

NPI: 1003025370
Provider Name (Legal Business Name): SARA LEVINE MCCAFFREY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 09/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 E 12TH ST
THE DALLES OR
97058-3213
US

IV. Provider business mailing address

PO BOX 1520
THE DALLES OR
97058
US

V. Phone/Fax

Practice location:
  • Phone: 541-296-9151
  • Fax: 541-296-9156
Mailing address:
  • Phone: 541-296-9151
  • Fax: 541-296-9156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number174344-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD151411
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: