Healthcare Provider Details

I. General information

NPI: 1306395819
Provider Name (Legal Business Name): CIGANEK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

633 RAILROAD AVE
CENTREVILLE MD
21617-1144
US

IV. Provider business mailing address

633 RAILROAD AVE
CENTREVILLE MD
21617-1144
US

V. Phone/Fax

Practice location:
  • Phone: 410-758-2732
  • Fax: 410-758-0012
Mailing address:
  • Phone: 410-758-2732
  • Fax: 410-758-0012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC CIGANEK
Title or Position: PRESIDENT
Credential:
Phone: 410-758-2732