Healthcare Provider Details

I. General information

NPI: 1376872580
Provider Name (Legal Business Name): BETH ANN BUGHMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2009
Last Update Date: 06/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

PO BOX 64664
BALTIMORE MD
21264-4664
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-1830
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC04176
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: