Provider Demographics
NPI:1578530812
Name:ERGAS, SANDERS S (MD)
Entity Type:Individual
Prefix:
First Name:SANDERS
Middle Name:S
Last Name:ERGAS
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:PO BOX 602484
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2484
Mailing Address - Country:US
Mailing Address - Phone:910-256-6222
Mailing Address - Fax:910-256-0011
Practice Address - Street 1:1135 MILITARY CUTOFF RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-3966
Practice Address - Country:US
Practice Address - Phone:910-256-6222
Practice Address - Fax:910-256-0011
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD019901E207P00000X
NC2008-01083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911964Medicaid
PA007033077Medicaid
NC1578530812Medicaid
NC1578530812Medicaid
PA188372Medicare PIN
NC5911964Medicaid
B40921Medicare UPIN