Basic Information
| Provider Information | |||||||||
| NPI: | 1356907687 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOU NADER | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 55 LAKE AVENUE NORTH | ||||||||
| Address2: | |||||||||
| City: | WORCESTER | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5083341000 | ||||||||
| FaxNumber: | 5083346404 | ||||||||
| Practice Location | |||||||||
| Address1: | 151 WORCESTER RD | ||||||||
| Address2: | FAMILY MEDICINE | ||||||||
| City: | BARRE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 01005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783556321 | ||||||||
| FaxNumber: | 9783556329 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/13/2019 | ||||||||
| LastUpdateDate: | 01/10/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.