Provider Demographics
NPI:1104919752
Name:ELMENDORF, SARAH L
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:L
Last Name:ELMENDORF
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:L
Other - Last Name:DISTEFANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:UPSTATE INFECTIOUS DISEASES ASSOCIATES
Mailing Address - Street 2:404 NEW SCOTLAND AVE
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208
Mailing Address - Country:US
Mailing Address - Phone:518-435-0662
Mailing Address - Fax:518-435-0664
Practice Address - Street 1:UPSTATE INFECTIOUS DISEASES ASSOCIATES
Practice Address - Street 2:404 NEW SCOTLAND AVE
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-435-0662
Practice Address - Fax:518-435-0664
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY153286207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000402902001OtherBLUE SHIELD
NY925121OtherBLUE CROSS
NY01051183Medicaid
NY10028381OtherCDPHP
B82878Medicare UPIN
56492DMedicare ID - Type Unspecified