Healthcare Provider Details

I. General information

NPI: 1386681898
Provider Name (Legal Business Name): KEVIN SCRUGGS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

5601 LOCH RAVEN BLVD
BALTIMORE MD
21239-2905
US

V. Phone/Fax

Practice location:
  • Phone: 443-444-4820
  • Fax: 443-444-5957
Mailing address:
  • Phone: 443-444-4820
  • Fax: 443-444-5957

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberD38543
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: