Provider Demographics
NPI:1275736977
Name:SCRUGGS, KRISTINE VISSAGE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINE
Middle Name:VISSAGE
Last Name:SCRUGGS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CLAUDIA
Other - Middle Name:KRISTINE
Other - Last Name:VISSAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1900 KILDAIRE FARM RD
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-6616
Mailing Address - Country:US
Mailing Address - Phone:919-350-1965
Mailing Address - Fax:919-350-1980
Practice Address - Street 1:1900 KILDAIRE FARM RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27518-6616
Practice Address - Country:US
Practice Address - Phone:919-350-1965
Practice Address - Fax:919-350-1980
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-02075207R00000X, 208M00000X
NC141146390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC76247UMedicare UPIN