MEDICARE: JACOB BUGENHAGEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	30850	MD

General Provider Information

NPI Number	:	1134051394
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB BUGENHAGEN

Provider Business Mailing Address
First Line	:	497 TULIP RD
Second Line	:
City	:	ANNAPOLIS
State	:	MD
Zip	:	21403-1323
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 KERNAN DR
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21207-6665
Country	:	US
Telephone Number	:	410-448-2500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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Directions to “ JACOB BUGENHAGEN ” Practice Location

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