Provider Demographics
NPI:1609824481
Name:BEBLA, SARGON (MD)
Entity Type:Individual
Prefix:DR
First Name:SARGON
Middle Name:
Last Name:BEBLA
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 1:739 IRVING AVE
Mailing Address - Street 2:SUITE 640
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13210-1640
Mailing Address - Country:US
Mailing Address - Phone:315-299-8150
Mailing Address - Fax:315-299-8155
Practice Address - Street 1:739 IRVING AVE
Practice Address - Street 2:SUITE 640
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13210-1640
Practice Address - Country:US
Practice Address - Phone:315-299-8150
Practice Address - Fax:315-299-8155
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT2323207VF0040X
CAA79656208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7446428OtherAETNA
NYJ100000077OtherPTAN
NY126364OtherBLUE CROSS
NY2099796Medicaid
NYPOMCOOther161488013
NY699354OtherMVP
NY7446428OtherAETNA