Provider Demographics
NPI:1902807647
Name:SUGALSKI, KEVIN A (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:A
Last Name:SUGALSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:322 WARREN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-3443
Mailing Address - Country:US
Mailing Address - Phone:814-288-4498
Mailing Address - Fax:814-288-1525
Practice Address - Street 1:322 WARREN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-3443
Practice Address - Country:US
Practice Address - Phone:814-288-4498
Practice Address - Fax:814-288-1525
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2012-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOS011040L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E52469Medicare UPIN
PA045606Medicare PIN