Provider Demographics
NPI:1023002235
Name:ECONOMIDES, AGLAE (MD)
Entity Type:Individual
Prefix:DR
First Name:AGLAE
Middle Name:
Last Name:ECONOMIDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AGLAE
Other - Middle Name:KOUMBOURLI
Other - Last Name:ECONOMIDES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3100 WYMAN PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21211-2803
Mailing Address - Country:US
Mailing Address - Phone:410-338-3500
Mailing Address - Fax:
Practice Address - Street 1:6000 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 625
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3803
Practice Address - Country:US
Practice Address - Phone:240-314-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10794208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3194209Medicaid
MD376751500Medicaid
MDS732Medicare PIN
TN3194209Medicaid
TNG14462Medicare UPIN