Provider Demographics
NPI:1497915441
Name:DAVID JOHN SUGARMAN, M.D.INC.
Entity Type:Organization
Organization Name:DAVID JOHN SUGARMAN, M.D.INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SUGARMAN
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:650-697-3721
Mailing Address - Street 1:1750 EL CAMINO REAL STE 202
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3214
Mailing Address - Country:US
Mailing Address - Phone:650-697-3721
Mailing Address - Fax:650-697-6105
Practice Address - Street 1:1750 EL CAMINO REAL STE 202
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3214
Practice Address - Country:US
Practice Address - Phone:650-697-3721
Practice Address - Fax:650-697-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA22822207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A228220Medicaid
CA00A228220Medicaid
CA00A228220Medicare PIN