Provider Demographics
NPI:1447403456
Name:SUGAR, MELISSA DIANE (MD)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:DIANE
Last Name:SUGAR
Suffix:
Gender:F
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:PO BOX 26666
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1010 SPRUCE STREET
Practice Address - Street 2:HOSPITALIST-ESPANOLA
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2746
Practice Address - Country:US
Practice Address - Phone:505-753-7111
Practice Address - Fax:053-670-2885
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2012-0505207R00000X
CO49967207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOAAA0754Medicare UPIN