Provider Demographics
NPI:1114997137
Name:SUGIN, STEPHANIE L (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:SUGIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1201 W MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06708-3105
Mailing Address - Country:US
Mailing Address - Phone:203-597-9100
Mailing Address - Fax:203-401-6517
Practice Address - Street 1:1201 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3105
Practice Address - Country:US
Practice Address - Phone:203-597-9100
Practice Address - Fax:203-596-4758
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT032548207W00000X
CT32548207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT180000559OtherMEDICARE PTAN
CT180000559OtherMEDICARE PTAN