Provider Demographics
NPI:1417946849
Name:SARGINGER, LARRY (MD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:SARGINGER
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 1:101 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-1277
Mailing Address - Country:US
Mailing Address - Phone:814-975-1033
Mailing Address - Fax:814-975-1036
Practice Address - Street 1:101 WALNUT ST
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-1277
Practice Address - Country:US
Practice Address - Phone:814-975-1033
Practice Address - Fax:814-975-1036
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD027499E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000972608Medicaid
PA0009726080008Medicaid
PA000972608Medicaid
PA0009726080008Medicaid