Provider Demographics
NPI:1124236633
Name:HEIDT, SARAH S (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:S
Last Name:HEIDT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:SELICKMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4371 FERGUSON DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1668
Mailing Address - Country:US
Mailing Address - Phone:513-752-3650
Mailing Address - Fax:513-752-3387
Practice Address - Street 1:4371 FERGUSON DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1668
Practice Address - Country:US
Practice Address - Phone:513-752-3650
Practice Address - Fax:513-752-3387
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2013-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH91129208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics