Provider Demographics
NPI:1285634105
Name:SERGOTT, ROBERT CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:CHARLES
Last Name:SERGOTT
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 1:840 WALNUT ST
Mailing Address - Street 2:SUITE 930
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5109
Mailing Address - Country:US
Mailing Address - Phone:215-928-3130
Mailing Address - Fax:215-592-1923
Practice Address - Street 1:840 WALNUT ST
Practice Address - Street 2:SUITE 930
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5109
Practice Address - Country:US
Practice Address - Phone:215-928-3130
Practice Address - Fax:215-592-1923
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD018980E207W00000X, 207WX0109X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0053049000OtherINDEPENDENCE BLUE CROSS
PA000824033Medicaid
PA004332OtherHIGHMARK BLUE SHIELD
PA000824033Medicaid
PA004332Medicare PIN
PA004332OtherHIGHMARK BLUE SHIELD
DE132782Medicare PIN