Provider Demographics
NPI:1740711241
Name:SUGUITAN, AMORSOLO LAJA JR (MD, MSC, PHD)
Entity type:Individual
Prefix:DR
First Name:AMORSOLO
Middle Name:LAJA
Last Name:SUGUITAN
Suffix:JR
Gender:M
Credentials:MD, MSC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5516 VIRGINIA BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-5629
Mailing Address - Country:US
Mailing Address - Phone:757-473-3969
Mailing Address - Fax:757-506-0157
Practice Address - Street 1:5516 VIRGINIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462-5629
Practice Address - Country:US
Practice Address - Phone:757-473-3969
Practice Address - Fax:757-506-0157
Is Sole Proprietor?:No
Enumeration Date:2017-03-26
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV20140207R00000X
VA0101280687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1740711241Medicaid
NV20140OtherSTATE LICENSE