MEDICARE: SARA BUCKELEW MD

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	208000000X	Pediatrics Physician	A71789	CA

General Provider Information

NPI Number	:	1841250750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA BUCKELEW MD

Provider Business Mailing Address
First Line	:	11875 DUBLIN BLVD
Second Line	:	SUITE B125
City	:	DUBLIN
State	:	CA
Zip	:	94568-2843
Country	:	US
Telephone Number	:	925-587-2505
Fax Number	:	925-587-2511

Provider Business Practice Location Address
First Line	:	3100 TELEGRAPH AVE
Second Line	:	2ND FLOOR
City	:	OAKLAND
State	:	CA
Zip	:	94609-3210
Country	:	US
Telephone Number	:	510-452-5231
Fax Number	:	510-869-6679

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	02/27/2012

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