Healthcare Provider Details

I. General information

NPI: 1184686826
Provider Name (Legal Business Name): SUSAN SUGARMAN KIRSCH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7011 FAYETTEVILLE RD STE 210
DURHAM NC
27713-7745
US

IV. Provider business mailing address

2000 PERIMETER PARK DR STE 200
MORRISVILLE NC
27560-8442
US

V. Phone/Fax

Practice location:
  • Phone: 919-806-3335
  • Fax: 919-215-2381
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number210071
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: