Healthcare Provider Details

I. General information

NPI: 1992728380
Provider Name (Legal Business Name): ERNEST UZICANIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 06/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19236 MEADOW VIEW DR
HAGERSTOWN MD
21742-2924
US

IV. Provider business mailing address

19236 MEADOW VIEW DR
HAGERSTOWN MD
21742-2924
US

V. Phone/Fax

Practice location:
  • Phone: 301-745-3695
  • Fax: 301-745-4572
Mailing address:
  • Phone: 301-745-3695
  • Fax: 301-745-4572

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD0040622
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: