Provider Demographics
NPI:1255333274
Name:UGGOWITZER, PETER G (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:G
Last Name:UGGOWITZER
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 1:814 HOUCKSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-1882
Mailing Address - Country:US
Mailing Address - Phone:410-239-0406
Mailing Address - Fax:410-239-0407
Practice Address - Street 1:814 HOUCKSVILLE RD
Practice Address - Street 2:
Practice Address - City:HAMPSTEAD
Practice Address - State:MD
Practice Address - Zip Code:21074-1882
Practice Address - Country:US
Practice Address - Phone:410-239-0406
Practice Address - Fax:410-239-0407
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD132311300Medicaid
F75868Medicare UPIN
707CMedicare ID - Type Unspecified