Provider Demographics
NPI:1225027956
Name:SUGARMAN, MICHAEL GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:GARY
Last Name:SUGARMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:774 CHRISTIANA RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-4236
Mailing Address - Country:US
Mailing Address - Phone:302-366-7671
Mailing Address - Fax:302-366-7649
Practice Address - Street 1:774 CHRISTIANA RD
Practice Address - Street 2:SUITE 202
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-4236
Practice Address - Country:US
Practice Address - Phone:302-366-7671
Practice Address - Fax:302-366-7649
Is Sole Proprietor?:No
Enumeration Date:2005-10-15
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0002708174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000098001Medicaid
DEF23954Medicare UPIN
DE886947Medicare ID - Type Unspecified