Provider Demographics
NPI:1144247172
Name:ROCHESTER, SARA CASTO (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:CASTO
Last Name:ROCHESTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:LYNN
Other - Last Name:CASTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:200 MESSIMER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3627
Mailing Address - Country:US
Mailing Address - Phone:220-564-4873
Mailing Address - Fax:220-564-4871
Practice Address - Street 1:200 MESSIMER DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3627
Practice Address - Country:US
Practice Address - Phone:220-564-4873
Practice Address - Fax:220-564-4871
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL191712084P0800X
KY483232084P0800X
OH350986212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0061619Medicaid
WV3810022795Medicaid
OHP101089818OtherRAILROAD MEDICARE
OHP101089818OtherRAILROAD MEDICARE
C60332Medicare UPIN
OH0061619Medicaid