Provider Demographics
NPI:1811932809
Name:SUGARMAN, LAURENCE IRWIN (MD)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:IRWIN
Last Name:SUGARMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 WHITE SPRUCE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14623-1610
Mailing Address - Country:US
Mailing Address - Phone:585-292-5830
Mailing Address - Fax:585-292-5847
Practice Address - Street 1:103 WHITE SPRUCE BLVD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-1610
Practice Address - Country:US
Practice Address - Phone:585-292-5830
Practice Address - Fax:585-429-2584
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY159792208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY101076DLOtherPREFERRED CARE # PEDS
NY159792-1WOtherWORKERS COMP #
NYMDJ303OtherPREFERRED CARE # FOR BH
NYP010159792OtherBLUE CHOICE #