Active NPI
Maria Aurora Canlas Sucgang, MD
- Pediatrics Physician
- Enterprise, AL
National Provider Identifier
1528049863
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 22576
- Practice address
- 101 Professional LN
Enterprise, AL 36330-2085 - Phone
- (334) 347-3404
- Fax
- (334) 393-0613
- NPI assigned
- Nov 11, 2005
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 22576 | AL | Primary |
Addresses
Primary practice location
101 Professional LN
Enterprise, AL 36330-2085
Mailing address
101 Professional LN
Enterprise, AL 36330-2085
Phone (334) 347-3404
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AL
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22576 | AL | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Houston County Healthcare Authority | Pediatrics | Current | Accepting new patients |
| Houston County Healthcare Authority | Current | Accepting new patients | |
| Houston County Healthcare Authority | Current | Accepting new patients | |
| Houston County Healthcare Authority | Current | Accepting new patients | |
| Southeast Alabama Medical Center Employee Pharmacy | Past | Accepting new patients |
Locations
1108 Ross Clark Cir
Dothan, AL 36301
Phone (334) 712-3635
1118 Ross Clark Cir
Ste 500
Dothan, AL 36301
Phone (334) 794-4159
101 Professional Ln
Enterprise, AL 36330
Phone (334) 347-3404
Interoperability endpoints
- msucgang14467@southeasthealth.direct-ci.com
Organizations & group practices 5
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Internal Medicine Physician
- Enterprise, AL
- NPI 1619026606
Pediatrics
-
- Clinical Medical Laboratory
- Dothan, AL
- NPI 1114161601
-
- Internal Medicine Physician
- Dothan, AL
- NPI 1285783134
-
- Internal Medicine Physician
- Dothan, AL
- NPI 1538597349
-
- Pharmacy
- Dothan, AL
- NPI 1053526368
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1131667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1331164800000",
"number": "1528049863",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "101 PROFESSIONAL LN",
"city": "ENTERPRISE",
"state": "AL",
"postal_code": "363302085",
"telephone_number": "334-347-3404",
"fax_number": "334-393-0613"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 PROFESSIONAL LN",
"city": "ENTERPRISE",
"state": "AL",
"postal_code": "363302085",
"telephone_number": "334-347-3404",
"fax_number": "334-393-0613"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUCGANG",
"first_name": "MARIA AURORA",
"middle_name": "CANLAS",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-11-11",
"last_updated": "2012-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "AL",
"license": "22576",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Enterprise, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.