Individual
MARISE L SUGARMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
111 GROSSMAN DR, BRAINTREE, MA 02184-4997
(781) 849-1000
Mailing address
147 MILK ST, PROVIDER ENROLLMENT - 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8239
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
123290
MA
363LP0200X
Pediatric Nurse Practitioner
Primary
123290
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0359700
—
MA
01
—
NP9992
BLUE CROSS
MA
01
—
PN740
HARVARD PILGRIM
MA
Enumeration date
03/08/2006
Last updated
01/10/2014
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