1598737496 NPI number — DR. THOMAS ANDREW SUGDEN PSYD

Table of content: DR. THOMAS ANDREW SUGDEN PSYD (NPI 1598737496)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598737496 NPI number — DR. THOMAS ANDREW SUGDEN PSYD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SUGDEN
Provider First Name:
THOMAS
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSYD
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:
1598737496
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3419 VIRGINIA BEACH BLVD # 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIRGINIA BEACH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23452-4419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-714-1838
Provider Business Mailing Address Fax Number:
757-321-6269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
228 N LYNNHAVEN RD STE 110
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIRGINIA BEACH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23452-7514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-201-2927
Provider Business Practice Location Address Fax Number:
757-321-6269
Provider Enumeration Date:
02/03/2006

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: 103TC0700X , with the licence number:  0810003305 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0100358G8 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 279306 . This is a "ANTHEM PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 279306 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 573544 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: C01884 . This is a "MCARE GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 279306 . This is a "ANTHEM HEALTHKEEPERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 085989M . This is a "SENTARA OPTIMA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 234201 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2114650 . This is a "MAMSI" identifier . This identifiers is of the category "OTHER".




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