=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073475786
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. RICHARD JOSEPH SUGHRUE III
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/01/2025
-----------------------------------------------------
Last Update Date | 12/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3130 STATE HWY RTE 6
-----------------------------------------------------
City | WELLFLEET
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02667-7402
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-349-3131
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10 SEASHORE PARK DR APT F
-----------------------------------------------------
City | PROVINCETOWN
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02657-1553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-645-3995
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | RN2315210
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------