Healthcare Provider Details

I. General information

NPI: 1558875401
Provider Name (Legal Business Name): CATHERINE NAGLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2017
Last Update Date: 11/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 ST. PAUL PLACE 6TH FLOOR
BALTMORE MD
21202
US

IV. Provider business mailing address

301 ST. PAUL PLACE MEDICAL STAFF OFFICE
BALTIMORE MD
21202
US

V. Phone/Fax

Practice location:
  • Phone: 410-385-5151
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC06613
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: