MEDICARE: DR. OSCAR FERNANDO SUGASTTI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101239590	VA
2	208000000X	Pediatrics Physician	D0068004	MD

General Provider Information

NPI Number	:	1255330759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. OSCAR FERNANDO SUGASTTI M.D.

Provider Business Mailing Address
First Line	:	14009 MINNIEVILLE RD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2310
Country	:	US
Telephone Number	:	703-580-6400
Fax Number	:	703-580-6402

Provider Business Practice Location Address
First Line	:	14009 MINNIEVILLE ROAD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193
Country	:	US
Telephone Number	:	703-580-6400
Fax Number	:	703-580-6402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	04/19/2012

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