Provider Demographics
NPI:1104879766
Name:CHARNECKI, SARA ELIZABETH (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ELIZABETH
Last Name:CHARNECKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MILL RD STE 180
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-5255
Mailing Address - Country:US
Mailing Address - Phone:508-973-2000
Mailing Address - Fax:508-973-2001
Practice Address - Street 1:1800 MAIN RD
Practice Address - Street 2:
Practice Address - City:TIVERTON
Practice Address - State:RI
Practice Address - Zip Code:02878-4625
Practice Address - Country:US
Practice Address - Phone:401-625-5552
Practice Address - Fax:401-625-5277
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD16814207Q00000X
ME017812207Q00000X
CO49784207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88308049Medicaid
COCOAAA0043Medicare PIN
CO88308049Medicaid
ME000595902Medicare PIN
I24813Medicare UPIN
ME432943699Medicaid
COCOAAA0043Medicare PIN