Provider Demographics
NPI:1043482789
Name:RITCHIE, SARAH TATUM (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:TATUM
Last Name:RITCHIE
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 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-273-5400
Mailing Address - Fax:352-273-5260
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-3003
Practice Address - Country:US
Practice Address - Phone:352-273-5400
Practice Address - Fax:352-273-5260
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME109543208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004001100Medicaid
FLFI537ZMedicare PIN