Provider Demographics
NPI:1366536237
Name:SERGENT, BERNIE NORMAN (DO)
Entity type:Individual
Prefix:
First Name:BERNIE
Middle Name:NORMAN
Last Name:SERGENT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1490 PARK AVE NW
Mailing Address - Street 2:SUITE 3
Mailing Address - City:NORTON
Mailing Address - State:VA
Mailing Address - Zip Code:24273-1631
Mailing Address - Country:US
Mailing Address - Phone:276-679-8890
Mailing Address - Fax:276-679-9740
Practice Address - Street 1:1490 PARK AVE NW
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTON
Practice Address - State:VA
Practice Address - Zip Code:24273-1631
Practice Address - Country:US
Practice Address - Phone:276-679-8890
Practice Address - Fax:276-679-9740
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02942207R00000X
VA0102202121207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100048180Medicaid
VAP00652501OtherRAILROAD MEDICARE
P01382768OtherRR MEDICARE
VA1366536237Medicaid
VAP00652501OtherRAILROAD MEDICARE
VAC09112Medicare UPIN
VAC10456Medicare UPIN
VA015426D11Medicare PIN
VAVVG985AMedicare PIN
KY7100048180Medicaid