Provider Demographics
NPI:1770569493
Name:SARGENT, RONALD R (PA-C)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:R
Last Name:SARGENT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 FREIGHT SHED RD
Mailing Address - Street 2:
Mailing Address - City:BALDWINVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01436-1525
Mailing Address - Country:US
Mailing Address - Phone:978-652-4073
Mailing Address - Fax:978-939-1110
Practice Address - Street 1:184 FREIGHT SHED RD
Practice Address - Street 2:
Practice Address - City:BALDWINVILLE
Practice Address - State:MA
Practice Address - Zip Code:01436-1525
Practice Address - Country:US
Practice Address - Phone:978-652-4073
Practice Address - Fax:978-939-1110
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA880363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAS73881Medicare UPIN
MAAP0992Medicare ID - Type Unspecified