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General NPI Number Information
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NPI Number | 1447403456
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Entity Type | Individual
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Provider Name | MELISSA DIANE SUGAR M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/04/2008
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Last Update Date | 06/27/2024
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Provider Practice Location Address
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Address Line | 1010 SPRUCE STREET HOSPITALIST-ESPANOLA
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City | ESPANOLA
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State | NM
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Zip | 87532-2746
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Country | US
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Telephone | 505-753-7111
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Fax | 53-670-2885
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Provider Business Mailing Address
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Address Line | PO BOX 26666
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City | ALBUQUERQUE
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State | NM
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Zip | 87125-6666
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD2012-0505
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License Number State | NM
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