Healthcare Provider Details

I. General information

NPI: 1821093055
Provider Name (Legal Business Name): RALPH LAWRENCE KUGLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11110 MEDICAL CAMPUS RD SUITE 107
HAGERSTOWN MD
21742-6700
US

IV. Provider business mailing address

13308 CANTERBURY DR
HAGERSTOWN MD
21742-2600
US

V. Phone/Fax

Practice location:
  • Phone: 301-714-4427
  • Fax: 301-714-4424
Mailing address:
  • Phone: 301-739-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0026579
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: