1528060837 NPI number — MR. JOHN B SARGEANT PT

Table of content: MR. JOHN B SARGEANT PT (NPI 1528060837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528060837 NPI number — MR. JOHN B SARGEANT PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARGEANT
Provider First Name:
JOHN
Provider Middle Name:
B
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528060837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1939 OLD ANNAPOLIS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOODBINE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21797-8201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-854-6748
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6000 EXECUTIVE BLVD
Provider Second Line Business Practice Location Address:
STE 201
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-3803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-816-0020
Provider Business Practice Location Address Fax Number:
301-816-0334
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  14262 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0129008 . This is a "AETNA HMO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4296824 . This is a "AETNA PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: K366 . This is a "BC/BS NON PROVIDER#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4074069 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 230033 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 38311 . This is a "MDIPA/ALLIANCE/MLH/OC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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