Provider Demographics
NPI:1720081433
Name:SARGEANT, WALT G (MD)
Entity Type:Individual
Prefix:
First Name:WALT
Middle Name:G
Last Name:SARGEANT
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 1:464 W 145TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10031-4701
Mailing Address - Country:US
Mailing Address - Phone:212-926-5050
Mailing Address - Fax:
Practice Address - Street 1:464 W 145TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031-4701
Practice Address - Country:US
Practice Address - Phone:212-926-5050
Practice Address - Fax:212-926-7778
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYI32003Medicare UPIN