1134758329 NPI number — MR. DAVIS ANDREW SUGAR M.D

Table of content: MR. DAVIS ANDREW SUGAR M.D (NPI 1134758329)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134758329 NPI number — MR. DAVIS ANDREW SUGAR M.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUGAR
Provider First Name:
DAVIS
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
M.D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134758329
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 EMERALD HEIGHTS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STOUFFVILLE
Provider Business Mailing Address State Name:
ONTARIO
Provider Business Mailing Address Postal Code:
LAG 187
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 RIVERSIDE CIRCLE, SUITE 401, ROANOKE, VA, 24016
Provider Second Line Business Practice Location Address:
SUITE 401
Provider Business Practice Location Address City Name:
ROANOKE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-981-8247
Provider Business Practice Location Address Fax Number:
540-266-5843
Provider Enumeration Date:
04/08/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)