Healthcare Provider Details

I. General information

NPI: 1790245421
Provider Name (Legal Business Name): FUMITAKA SUGIGUCHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2019
Last Update Date: 06/29/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12254 ROCKVILLE PIKE
ROCKVILLE MD
20852
US

IV. Provider business mailing address

12254 ROCKVILLE PIKE
ROCKVILLE MD
20852
US

V. Phone/Fax

Practice location:
  • Phone: 301-230-2767
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD0094460
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: