Individual
GARY J SERGOTT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
19 FONTANA LN, SUITE 104, BALTIMORE, MD 21237-3047
(410) 574-7776
(410) 574-9038
Mailing address
PO BOX 1786, EASTON, MD 21601-8935
(410) 819-0710
(410) 819-0712
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R054914
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
214791200
—
MD
Enumeration date
11/16/2005
Last updated
03/14/2019
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