Provider Demographics
NPI:1437281318
Name:SARGENT, CHALA (MD)
Entity Type:Individual
Prefix:
First Name:CHALA
Middle Name:
Last Name:SARGENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 GORDON LN
Mailing Address - Street 2:
Mailing Address - City:NORTH WALES
Mailing Address - State:PA
Mailing Address - Zip Code:19454-4277
Mailing Address - Country:US
Mailing Address - Phone:267-439-6542
Mailing Address - Fax:215-472-7296
Practice Address - Street 1:111 N 49TH ST
Practice Address - Street 2:FHC FIRST FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19139-2718
Practice Address - Country:US
Practice Address - Phone:215-472-7291
Practice Address - Fax:215-472-7296
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD042321L2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012140840008OtherDPW PROMISE #