Provider Demographics
NPI:1699711895
Name:USCG CLINIC
Entity type:Organization
Organization Name:USCG CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CERTIFIED MEDICAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBINNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JAGDHUBER
Authorized Official - Suffix:
Authorized Official - Credentials:CMA
Authorized Official - Phone:410-636-7506
Mailing Address - Street 1:2401 HAWKINS POINT RD
Mailing Address - Street 2:
Mailing Address - City:CURTIS BAY
Mailing Address - State:MD
Mailing Address - Zip Code:21226-1795
Mailing Address - Country:US
Mailing Address - Phone:410-636-7506
Mailing Address - Fax:410-636-7868
Practice Address - Street 1:2401 HAWKINS POINT RD
Practice Address - Street 2:
Practice Address - City:CURTIS BAY
Practice Address - State:MD
Practice Address - Zip Code:21226-1797
Practice Address - Country:US
Practice Address - Phone:410-636-7506
Practice Address - Fax:410-636-7868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient