Healthcare Provider Details

I. General information

NPI: 1689859407
Provider Name (Legal Business Name): SARAH V COLONNA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 11/12/2021
Certification Date: 11/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 CIRCLE OF HOPE CLINIC 2E
SALT LAKE CITY UT
84112-5550
US

IV. Provider business mailing address

127 SO. 500 EAST #600
SALT LAKE CITY UT
84102-1971
US

V. Phone/Fax

Practice location:
  • Phone: 801-585-0100
  • Fax: 801-581-7169
Mailing address:
  • Phone: 801-587-6705
  • Fax: 801-715-8228

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number8211251-1205
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number8211251-1205
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: