MEDICARE: SARA JO DORROTHY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	100905	MA

General Provider Information

NPI Number	:	1710708045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA JO DORROTHY PA-C

Provider Business Mailing Address
First Line	:	88 WASHINGTON ST APT 14
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-4340
Country	:	US
Telephone Number	:	973-903-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	179 LONGWOOD AVE
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02115-5804
Country	:	US
Telephone Number	:	973-903-5656
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2024
Last Update Date	:	06/02/2026

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Directions to “ SARA JO DORROTHY PA-C” Practice Location

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