Provider Demographics
NPI:1053750240
Name:WHITEHEAD, SARA (MD)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials:MD
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 68
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94302-0068
Mailing Address - Country:US
Mailing Address - Phone:650-250-2434
Mailing Address - Fax:
Practice Address - Street 1:310 BRYANT ST
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-1407
Practice Address - Country:US
Practice Address - Phone:650-250-2434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-20
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA91423207N00000X
CAA914243207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty