1023010857 NPI number — MR. JEREMY WAYNE CUGLE MPT

Table of content: MR. JEREMY WAYNE CUGLE MPT (NPI 1023010857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023010857 NPI number — MR. JEREMY WAYNE CUGLE MPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CUGLE
Provider First Name:
JEREMY
Provider Middle Name:
WAYNE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MPT
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023010857
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2448 HOLLY AVE
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-3148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-295-4941
Provider Business Mailing Address Fax Number:
410-295-5207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2448 HOLLY AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ANNAPOLIS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21401-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-295-4941
Provider Business Practice Location Address Fax Number:
410-295-5207
Provider Enumeration Date:
08/11/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  20643 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 212822 . This is a "JOHNS HOPKINS HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 6100992 . This is a "MAMSI LIFE & HEALTH" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2431344 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5536592 . This is a "CCN NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 2228952 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: P00247396 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: T6710010 . This is a "BCBS OF DC" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 618243-05 . This is a "BLUECROSS BLUESHIELD MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 624853 . This is a "NATIONAL CAPITAL PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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