MEDICARE: MARISSA DUGAN ATC

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	2255A2300X	Athletic Trainer	060102178

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	060102178	OTHER		NATA CERTIFICATION NUMBER

General Provider Information

NPI Number	:	1922071299
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA DUGAN ATC

Provider Business Mailing Address
First Line	:	1203 PHILADELPHIA AVE. UNIT #2
Second Line	:
City	:	OCEAN CITY
State	:	MD
Zip	:	21842
Country	:	US
Telephone Number	:	410-430-1238
Fax Number	:

Provider Business Practice Location Address
First Line	:	1203 PHILADELPHIA AVE UNIT 2
Second Line	:
City	:	OCEAN CITY
State	:	MD
Zip	:	21842-3675
Country	:	US
Telephone Number	:	410-430-1238
Fax Number	:

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

Provider Enumeration Date	:	02/08/2006
Last Update Date	:	09/17/2008

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