Provider Demographics
NPI:1124020714
Name:CAGLE, COLLEEN C (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:C
Last Name:CAGLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1475 TANEY AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4747
Mailing Address - Country:US
Mailing Address - Phone:301-662-0133
Mailing Address - Fax:240-379-6710
Practice Address - Street 1:1475 TANEY AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4747
Practice Address - Country:US
Practice Address - Phone:301-662-0133
Practice Address - Fax:240-379-6710
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD00574322080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD812203200Medicaid