Provider Demographics
NPI:1679703730
Name:LAY, SARA E (MD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:LAY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:E
Other - Last Name:BECKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:250 N SHADELAND AVENUE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:317-963-2514
Mailing Address - Fax:
Practice Address - Street 1:714 N. SENATE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-3297
Practice Address - Country:US
Practice Address - Phone:317-944-1837
Practice Address - Fax:317-715-6415
Is Sole Proprietor?:No
Enumeration Date:2009-07-22
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125-0564872085R0202X
IN01075465A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201293890Medicaid
INP01561792Medicare PIN
IN959090023Medicare PIN