Provider Demographics
NPI:1992930408
Name:WASSERMAN, SARA DANA (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:DANA
Last Name:WASSERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3737 MARKET ST FL 6
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19104-5545
Mailing Address - Country:US
Mailing Address - Phone:215-662-2454
Mailing Address - Fax:215-662-7527
Practice Address - Street 1:3737 MARKET ST FL 6
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19104
Practice Address - Country:US
Practice Address - Phone:215-662-2454
Practice Address - Fax:215-662-7527
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD459659207RR0500X, 207RR0500X
NC2014-00866207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032597940001Medicaid