Provider Demographics
NPI:1205820438
Name:SERGI, THOMAS J (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:J
Last Name:SERGI
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:PO BOX 1710
Mailing Address - Street 2:SOUTH JERSEY RADIOLOGY ASSOCIATES, PA
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-7710
Mailing Address - Country:US
Mailing Address - Phone:856-770-0300
Mailing Address - Fax:856-770-0395
Practice Address - Street 1:100 CARNIE BLVD
Practice Address - Street 2:SUITE B-5
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4512
Practice Address - Country:US
Practice Address - Phone:856-751-0123
Practice Address - Fax:856-751-0535
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA040858002085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0109327000OtherAMERIHEALTH
SE504421OtherPREMIER BLUE
1243570OtherUNITED HEALTHCARE
A3738029OtherOXFORD HEALTH
1090818OtherHORIZON NJ HEALTH
SE504421OtherHIGHMARK PA BLUE SHIELD
0732408OtherAETNA
NJ1864904Medicaid
300047119OtherRAILROAD MEDICARE
0109327000OtherAMERIHEALTH
NJ504421A2DMedicare PIN