=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770849994
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SARA ZAFAR M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/02/2012
-----------------------------------------------------
Last Update Date | 01/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 37 W GARDEN ST SUITE #201
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13021-2662
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-567-0777
-----------------------------------------------------
Fax | 315-702-8393
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 17 LANSING ST AMMS, PC CREDENTIALING OFFICE
-----------------------------------------------------
City | AUBURN
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 13021-1983
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 315-567-0455
-----------------------------------------------------
Fax | 315-253-1795
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 58873
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 282743
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------