Provider Demographics
NPI:1033104468
Name:SARGERO, THOMAS VINCENT JR (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:VINCENT
Last Name:SARGERO
Suffix:JR
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 1:1010 CEREAL AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45013-2784
Mailing Address - Country:US
Mailing Address - Phone:513-867-2811
Mailing Address - Fax:513-867-2094
Practice Address - Street 1:1010 CEREAL AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45013-2784
Practice Address - Country:US
Practice Address - Phone:513-867-2811
Practice Address - Fax:513-867-2094
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2010-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052457207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0611734Medicaid
OH0611734Medicaid
OHSA0577473Medicare ID - Type Unspecified