Provider Demographics
NPI:1982608782
Name:DANNEBERGER, JOHN E (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:E
Last Name:DANNEBERGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:600 RIDGELY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1086
Mailing Address - Country:US
Mailing Address - Phone:410-266-8049
Mailing Address - Fax:410-266-8054
Practice Address - Street 1:600 RIDGELY AVE STE 222
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1073
Practice Address - Country:US
Practice Address - Phone:410-266-8049
Practice Address - Fax:410-266-8054
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2020-06-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0038324208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD547861800Medicaid
MD547861800Medicaid
MDE16794Medicare UPIN