Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO1000031 | DC |
N | 222Z00000X | Podiatrist | PO1000031 | DC |
Y | 213ES0103X | Foot & Ankle Surgery | PO1000031 | DC |
NPI | 1104033703 |
---|---|
Provider Name | Dr. Michangelo Darren Scruggs |
First Address | Washington, DC 20011-4228 |
Second Address | Washington, DC 20032-4689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2007 |
Last Update Date | 03/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
035237700 | (05) | DC |
947AMD- MD | CAREFIRST BC/BS (01) | DC |
J892 | CAREFRIST BC/BS (01) | DC |