Provider Demographics
NPI:1699128058
Name:CLOUGH, SARA (PHYSICIAN ASSISTANT)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:
Last Name:CLOUGH
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75420
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21275-5420
Mailing Address - Country:US
Mailing Address - Phone:703-383-6469
Mailing Address - Fax:703-385-1062
Practice Address - Street 1:1715 N GEORGE MASON DR STE 504
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3670
Practice Address - Country:US
Practice Address - Phone:703-525-2200
Practice Address - Fax:703-810-5423
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005420363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant