Provider Demographics
NPI:1578208773
Name:SUGIMOTO, SAM FORSBERG (MD)
Entity Type:Individual
Prefix:
First Name:SAM
Middle Name:FORSBERG
Last Name:SUGIMOTO
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 1:333 SOUTH COLUMBIA ST 126 MACNIDER HALL CB#7005
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27599-2286
Mailing Address - Country:US
Mailing Address - Phone:919-966-1216
Mailing Address - Fax:919-843-2356
Practice Address - Street 1:100 EASTOWNE DR
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-2286
Practice Address - Country:US
Practice Address - Phone:984-974-4462
Practice Address - Fax:919-843-9355
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program