Basic Information
| Provider Information | |||||||||
| NPI: | 1952417511 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDSBERRY | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | HELEN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5400 DUPONT CIRCLE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | MILFORD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451502770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135767700 | ||||||||
| FaxNumber: | 5135761020 | ||||||||
| Practice Location | |||||||||
| Address1: | 14 NORTH SECOND STREET | ||||||||
| Address2: | |||||||||
| City: | RIPLEY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 451671101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373924381 | ||||||||
| FaxNumber: | 9373924383 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 09/19/2012 | ||||||||
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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 | 207R00000X | 35076420 | OH | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2246046 | 05 | OH | MEDICAID | PO0422160 | 01 | OH | RAIL ROAD MEDICARE | OTHER | 200873970 | 05 | IN | MEDICAID |