Healthcare Provider Details

I. General information

NPI: 1366975195
Provider Name (Legal Business Name): PATRICK D SUGGS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2017
Last Update Date: 08/23/2023
Certification Date: 07/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 MACCORKLE AVE SE
CHARLESTON WV
25304-1223
US

IV. Provider business mailing address

216 SOUTHERN WOODS DR
CHARLESTON WV
25309-8691
US

V. Phone/Fax

Practice location:
  • Phone: 304-351-1600
  • Fax:
Mailing address:
  • Phone: 304-488-3484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number32793
License Number StateWV
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: