Provider Demographics
NPI:1730158346
Name:BOTT, SARAH E (PA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:E
Last Name:BOTT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ELIZABETH
Other - Last Name:SPANGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:730 THIMBLE SHOALS BLVD
Mailing Address - Street 2:STE 130
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4562
Mailing Address - Country:US
Mailing Address - Phone:757-873-1554
Mailing Address - Fax:757-873-3239
Practice Address - Street 1:5335 DISCOVERY PARK BLVD STE B
Practice Address - Street 2:
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23188-2696
Practice Address - Country:US
Practice Address - Phone:757-253-0603
Practice Address - Fax:757-585-7645
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA110002183363A00000X, 363A00000X
VA0110002183363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730158346Medicaid
VA10006638POtherSENTARA HEALTH PLANS
VAVV0444BMedicare PIN
009503H04Medicare ID - Type Unspecified
009503H04Medicare ID - Type Unspecified
VAP34023Medicare UPIN