Provider Demographics
NPI:1033483854
Name:SUGAR, BENJAMIN J (PA)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:SUGAR
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 KENSINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-5940
Mailing Address - Country:US
Mailing Address - Phone:608-244-2815
Mailing Address - Fax:
Practice Address - Street 1:325 KENSINGTON DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-5940
Practice Address - Country:US
Practice Address - Phone:608-244-2815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-24
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2890-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant