Provider Demographics
NPI:1144206483
Name:STRUCK, ALBERT J (PA)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:J
Last Name:STRUCK
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3500 BOSTON ST STE J1
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-5723
Mailing Address - Country:US
Mailing Address - Phone:410-522-0001
Mailing Address - Fax:410-522-0001
Practice Address - Street 1:3500 BOSTON ST STE J1
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-5723
Practice Address - Country:US
Practice Address - Phone:410-522-0001
Practice Address - Fax:410-522-0017
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCPA30220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC016876N64Medicare ID - Type Unspecified
S69527Medicare UPIN
MD683L343DMedicare PIN