Healthcare Provider Details

I. General information

NPI: 1407767940
Provider Name (Legal Business Name): SARAH BALTUCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1464 JEFFERSON ST N
LEWISBURG WV
24901-1380
US

IV. Provider business mailing address

139 SILO SQ UNIT 5
LEWISBURG WV
24901-2307
US

V. Phone/Fax

Practice location:
  • Phone: 304-645-3220
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: