Basic Information
| Provider Information | |||||||||
| NPI: | 1295703783 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SARGENT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 LONG POND DR | ||||||||
| Address2: | FONTAINE MEDICAL CENTER | ||||||||
| City: | HARWICH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084324100 | ||||||||
| FaxNumber: | 5084328951 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 LONG POND DR | ||||||||
| Address2: | FONTAINE MEDICAL CENTER | ||||||||
| City: | HARWICH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084324100 | ||||||||
| FaxNumber: | 5084328951 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 159337 | MA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | J21905 | 01 | MA | BCBS | OTHER | 3051749 | 05 | MA | MEDICAID | 710727 | 01 | MA | HPHC | OTHER |