MEDICARE: WALT G SARGEANT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	235917	NY

General Provider Information

NPI Number	:	1720081433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALT G SARGEANT M.D.

Provider Business Mailing Address
First Line	:	464 W 145TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-4701
Country	:	US
Telephone Number	:	212-926-5050
Fax Number	:

Provider Business Practice Location Address
First Line	:	464 W 145TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10031-4701
Country	:	US
Telephone Number	:	212-926-5050
Fax Number	:	212-926-7778

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/20/2015

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