Provider Demographics
NPI:1225030554
Name:CAMARGO, SERGIO (MD)
Entity Type:Individual
Prefix:
First Name:SERGIO
Middle Name:
Last Name:CAMARGO
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 1:110 LONG POND RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-2642
Mailing Address - Country:US
Mailing Address - Phone:508-746-2284
Mailing Address - Fax:508-727-5027
Practice Address - Street 1:110 LONG POND RD
Practice Address - Street 2:SUITE 205
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-2642
Practice Address - Country:US
Practice Address - Phone:508-746-2284
Practice Address - Fax:508-727-5027
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2009-07-06
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
MA75498207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA64170OtherPILGRIM
MA45117OtherONE HEALTH
MAJ13786OtherBLUE CROSS BLUE SHILED
MA043521141OtherUNITED HEALTHCARE
MA075498OtherTUFTS HEALTH PLAN
MA3111334Medicaid
MAJ13786Medicare ID - Type Unspecified
MA45117OtherONE HEALTH