Provider Demographics
NPI:1023011517
Name:SARGENT, ERIC RICHMOND (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:RICHMOND
Last Name:SARGENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 COLCHESTER AVENUE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401
Mailing Address - Country:US
Mailing Address - Phone:802-847-2884
Mailing Address - Fax:802-847-6020
Practice Address - Street 1:111 COLCHESTER AVENUE, EAST PAVILION 5
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401
Practice Address - Country:US
Practice Address - Phone:802-847-2884
Practice Address - Fax:802-847-6020
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26588208800000X
VT0420010146208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA71754OtherWELLMARK/BLUE CROSS/BLUE
CAG87836OtherCALIFORNIA LIC
VT0VN2503Medicaid
NY01786350Medicaid
37456OtherBLUE CROSS BLUE SHIELD
IA1023011517Medicaid
MO209143403Medicaid
42143522520OtherJOHN DEERE
421435525OtherTRI-CARE GROUP NUMBER
CAG87836OtherCALIFORNIA LIC
MO209143403Medicaid
37456OtherBLUE CROSS BLUE SHIELD