1437281318 NPI number — CHALA SARGENT MD

Table of content: CHALA SARGENT MD (NPI 1437281318)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437281318 NPI number — CHALA SARGENT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SARGENT
Provider First Name:
CHALA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1437281318
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 GORDON LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH WALES
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19454-4277
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
267-439-6542
Provider Business Mailing Address Fax Number:
215-472-7296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N 49TH ST
Provider Second Line Business Practice Location Address:
FHC FIRST FLOOR
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19139-2718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-472-7291
Provider Business Practice Location Address Fax Number:
215-472-7296
Provider Enumeration Date:
03/09/2007

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: 2084P0804X , with the licence number:  MD042321L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0012140840008 . This is a "DPW PROMISE #" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com