Healthcare Provider Details

I. General information

NPI: 1801196639
Provider Name (Legal Business Name): NISHAN KUGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2010
Last Update Date: 06/05/2025
Certification Date: 06/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 N 21ST ST
CAMP HILL PA
17011-2204
US

IV. Provider business mailing address

1643 NW 136TH AVE
SUNRISE FL
33323-2857
US

V. Phone/Fax

Practice location:
  • Phone: 717-972-4448
  • Fax: 717-972-7366
Mailing address:
  • Phone: 954-377-2939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD449285
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberCI-0025047
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: