Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 210071 | MA |
NPI | 1184686826 |
---|---|
Provider Name | Susan Sugarman Kirsch |
First Address | Morrisville, NC 27560-8442 |
Second Address | Durham, NC 27713-7745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/04/2006 |
Last Update Date | 10/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
210071 | TUFTS HEALTH PLAN (01) | MA |
5908794 | (05) | NC |
J24932 | BLUE CROSS BLUE SHIELD (01) | MA |