Provider Demographics
NPI:1235122680
Name:HAUGH, PATRICK (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:HAUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10403 HOSPITAL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3148
Mailing Address - Country:US
Mailing Address - Phone:301-531-9190
Mailing Address - Fax:301-531-9191
Practice Address - Street 1:10403 HOSPITAL DR STE 102
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3148
Practice Address - Country:US
Practice Address - Phone:301-531-9190
Practice Address - Fax:301-531-9191
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD45851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD406583200Medicaid
MDG30410Medicare UPIN