Provider Demographics
NPI:1972540128
Name:SAGALOWSKY, RONALD L (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:L
Last Name:SAGALOWSKY
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 1:126 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-6937
Mailing Address - Country:US
Mailing Address - Phone:207-778-4353
Mailing Address - Fax:207-778-4238
Practice Address - Street 1:126 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-6937
Practice Address - Country:US
Practice Address - Phone:207-778-4353
Practice Address - Fax:207-778-4238
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
METD061040208800000X
IN01022328A208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEB28789Medicare UPIN