Healthcare Provider Details

I. General information

NPI: 1073475786
Provider Name (Legal Business Name): MR. RICHARD JOSEPH SUGHRUE III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 STATE HWY RTE 6
WELLFLEET MA
02667-7402
US

IV. Provider business mailing address

10 SEASHORE PARK DR APT F
PROVINCETOWN MA
02657-1553
US

V. Phone/Fax

Practice location:
  • Phone: 508-349-3131
  • Fax:
Mailing address:
  • Phone: 617-645-3995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2315210
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: