Provider Demographics
NPI:1396066858
Name:TODD, SARAH PETTIGREW (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:PETTIGREW
Last Name:TODD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:LYNN
Other - Last Name:PETTIGREW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:113 LIVERPOOL DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35758-6295
Mailing Address - Country:US
Mailing Address - Phone:256-520-9852
Mailing Address - Fax:
Practice Address - Street 1:1963 MEMORIAL PKWY SW
Practice Address - Street 2:SUITE 5
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-5036
Practice Address - Country:US
Practice Address - Phone:256-265-2464
Practice Address - Fax:256-265-2466
Is Sole Proprietor?:No
Enumeration Date:2010-06-18
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AL32462208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program