Provider Demographics
NPI:1003964867
Name:SUGG, MITCHEL PAUL (CPO, CPED,FAAOP)
Entity Type:Individual
Prefix:
First Name:MITCHEL
Middle Name:PAUL
Last Name:SUGG
Suffix:
Gender:M
Credentials:CPO, CPED,FAAOP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1495
Mailing Address - Street 2:
Mailing Address - City:KINSTON
Mailing Address - State:NC
Mailing Address - Zip Code:28503-1495
Mailing Address - Country:US
Mailing Address - Phone:252-522-3278
Mailing Address - Fax:252-522-3280
Practice Address - Street 1:213 AIRPORT RD
Practice Address - Street 2:LENOIR CROSSING
Practice Address - City:KINSTON
Practice Address - State:NC
Practice Address - Zip Code:28504-8859
Practice Address - Country:US
Practice Address - Phone:252-522-3278
Practice Address - Fax:252-522-3280
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7705029Medicaid
NC7795129Medicaid
NC1861626723OtherPARTNERS (BCBS)
NC1861626723OtherBCBS (TRAD, PPO, MC)
NC7705029Medicaid