Provider Demographics
NPI:1194779116
Name:DUGAN, DANIELLE A (DO)
Entity type:Individual
Prefix:
First Name:DANIELLE
Middle Name:A
Last Name:DUGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19053 SAWYER TER
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-6228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1901 RESEARCH BLVD
Practice Address - Street 2:350
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3164
Practice Address - Country:US
Practice Address - Phone:301-838-9606
Practice Address - Fax:301-838-9029
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207623207L00000X
MDH61089207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD404626900Medicaid
601285800OtherFECA
I01356Medicare UPIN
MD015702F85Medicare ID - Type UnspecifiedMD MEDICARE GROUP G01485
MD839MK291Medicare ID - Type UnspecifiedMD MEDICARE GROUP 839M