Provider Demographics
NPI:1104033703
Name:SCRUGGS, MICHANGELO DARREN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHANGELO
Middle Name:DARREN
Last Name:SCRUGGS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4316 18TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011-4228
Mailing Address - Country:US
Mailing Address - Phone:202-412-9664
Mailing Address - Fax:
Practice Address - Street 1:1328 SOUTHERN AVE SE
Practice Address - Street 2:SUITE 209
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4689
Practice Address - Country:US
Practice Address - Phone:202-506-1001
Practice Address - Fax:202-506-1008
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPO1000031213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC947AMD- MDOtherCAREFIRST BC/BS
DCJ892OtherCAREFRIST BC/BS
DC035237700Medicaid
DC491626Medicare PIN