Provider Demographics
NPI:1417907593
Name:SARGE, TERENCE JOHN (MD)
Entity Type:Individual
Prefix:
First Name:TERENCE
Middle Name:JOHN
Last Name:SARGE
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 1:104 HILLCREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673
Mailing Address - Country:US
Mailing Address - Phone:814-224-5455
Mailing Address - Fax:814-224-5004
Practice Address - Street 1:104 HILLCREST DRIVE
Practice Address - Street 2:
Practice Address - City:ROARING SPRING
Practice Address - State:PA
Practice Address - Zip Code:16673
Practice Address - Country:US
Practice Address - Phone:814-224-5455
Practice Address - Fax:814-224-5004
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA031960E207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
306266OtherUPMC
36767OtherGEISINGER HEALTH
1534844OtherGATEWAY
191443OtherUNITED HEALTHCARE PHILIPS
216985OtherUNITED HEALTHCARE FLEMM
000000142530OtherTHREE RIVERS MED PLUS
PA0011421360005Medicaid
128094OtherKEYSTONE HEALTH PLAN WEST
217155OtherUNITED HEALTHCARE DEPHI
PASA128094OtherBLUE SHIELD
1142136OtherMEDICAID ACCESS MA
0011421360005OtherPROMISE PROVIDER ID #S
128094OtherHGS ADMINISTRATORS MCARE
128094OtherHGS ADMINISTRATORS MCARE
C31035Medicare UPIN