Provider Demographics
NPI:1548203722
Name:SARGEANT-HARDY, ROCHELLE (MD)
Entity Type:Individual
Prefix:
First Name:ROCHELLE
Middle Name:
Last Name:SARGEANT-HARDY
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 1:11004 FORESTGATE PL
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-2046
Mailing Address - Country:US
Mailing Address - Phone:301-464-5222
Mailing Address - Fax:
Practice Address - Street 1:12172 CENTRAL AVE
Practice Address - Street 2:100
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-1900
Practice Address - Country:US
Practice Address - Phone:301-249-2700
Practice Address - Fax:301-249-4559
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD37391207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0100483Medicaid
MD186615Medicare ID - Type Unspecified
MDE69313Medicare UPIN