Provider Demographics
NPI:1265483697
Name:SARGENT, WILLIAM ALAN (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ALAN
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 1:815 N KIRBY RD
Mailing Address - Street 2:
Mailing Address - City:LYNDONVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05851-9693
Mailing Address - Country:US
Mailing Address - Phone:802-626-8300
Mailing Address - Fax:802-626-4533
Practice Address - Street 1:815 N KIRBY RD
Practice Address - Street 2:
Practice Address - City:LYNDONVILLE
Practice Address - State:VT
Practice Address - Zip Code:05851-9693
Practice Address - Country:US
Practice Address - Phone:802-626-8300
Practice Address - Fax:802-626-4533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0006167207P00000X
NH9072207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004981Medicaid
NH30006246Medicaid
VTVT4981Medicare ID - Type Unspecified
VT0004981Medicaid