Healthcare Provider Details

I. General information

NPI: 1740534130
Provider Name (Legal Business Name): RYAN S SHUGARMAN MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2012
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N WASHINGTON ST STE 601
ALEXANDRIA VA
22314-1535
US

IV. Provider business mailing address

901 N. WASHINGTON ST. SUITE 601
ALEXANDRIA VA
22314-1535
US

V. Phone/Fax

Practice location:
  • Phone: 703-596-1024
  • Fax: 703-596-1573
Mailing address:
  • Phone: 703-596-1024
  • Fax: 703-596-1573

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084F0202X
TaxonomyForensic Psychiatry Physician
License Number0101245080
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101245080
License Number StateVA

VIII. Authorized Official

Name: DR. RYAN S. SHUGARMAN
Title or Position: BUSINESS OWNER
Credential: M.D.
Phone: 703-596-1024