Basic Information
| Provider Information | |||||||||
| NPI: | 1184943169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HARGETTE | ||||||||
| FirstName: | SUMAYAH | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 801 OSTRUM ST | ||||||||
| Address2: | |||||||||
| City: | BETHLEHEM | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845262200 | ||||||||
| FaxNumber: | 8668299836 | ||||||||
| Practice Location | |||||||||
| Address1: | 701 OSTRUM ST STE 202 | ||||||||
| Address2: | |||||||||
| City: | FOUNTAIN HILL | ||||||||
| State: | PA | ||||||||
| PostalCode: | 180151152 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4845262200 | ||||||||
| FaxNumber: | 4845262398 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2010 | ||||||||
| LastUpdateDate: | 07/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2015-01203 | NC | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | MD467281 | PA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1184943169 | 05 | NC | MEDICAID |