Provider Demographics
NPI:1366744831
Name:SUGARMAN, GRAYSON (MD)
Entity type:Individual
Prefix:DR
First Name:GRAYSON
Middle Name:
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 1:3805 EDWARDS RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45209-1900
Mailing Address - Country:US
Mailing Address - Phone:513-321-0833
Mailing Address - Fax:513-321-6063
Practice Address - Street 1:3805 EDWARDS RD
Practice Address - Street 2:SUITE 350
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45209-1900
Practice Address - Country:US
Practice Address - Phone:513-321-0833
Practice Address - Fax:513-321-6063
Is Sole Proprietor?:No
Enumeration Date:2010-12-03
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121366207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0089344Medicaid
OH0089344Medicaid