Basic Information
| Provider Information | |||||||||
| NPI: | 1295942621 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KHAVARI | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5100 SPRINGFIELD ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454311261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9372599900 | ||||||||
| FaxNumber: | 9372599999 | ||||||||
| Practice Location | |||||||||
| Address1: | 68 DARST RD | ||||||||
| Address2: | |||||||||
| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454403442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374586700 | ||||||||
| FaxNumber: | 9374586736 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2007 | ||||||||
| LastUpdateDate: | 12/02/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 35-090665 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2843230 | 05 | OH | MEDICAID |