Provider Demographics
NPI:1598170763
Name:ATALLAH, SARA (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:ATALLAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 HICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-1921
Mailing Address - Country:US
Mailing Address - Phone:513-939-3975
Mailing Address - Fax:
Practice Address - Street 1:1210 HICKS BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-1921
Practice Address - Country:US
Practice Address - Phone:513-939-3975
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD469843207RN0300X
OH35.143010207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH35.143010OtherSTATE LICENSE