Provider Demographics
NPI:1811529969
Name:SERGOJAN, ALEKSANDR VOLK (SO-IDC)
Entity type:Individual
Prefix:MR
First Name:ALEKSANDR
Middle Name:VOLK
Last Name:SERGOJAN
Suffix:
Gender:M
Credentials:SO-IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2734 HYDER AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-3033
Mailing Address - Country:US
Mailing Address - Phone:505-846-2761
Mailing Address - Fax:
Practice Address - Street 1:8810 SOUTH ST SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87117-0001
Practice Address - Country:US
Practice Address - Phone:505-846-2761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman