Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | 036814 | GA |
NPI | 1336201508 |
---|---|
Provider Name | Sara Marder |
First Address | Atlanta, GA 30342-1626 |
Second Address | Atlanta, GA 30342-1626 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
390507 | BCBS PIN NUMBER (01) | GA |
4671310 | AETNA PROV ID (01) | GA |
G06778 | (02) |