Provider Demographics
NPI:1275732786
Name:NAGEL, HEATHER DARLENE
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:DARLENE
Last Name:NAGEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:DARLENE
Other - Last Name:NAGEL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:3300 ELY RD
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-1120
Mailing Address - Country:US
Mailing Address - Phone:410-692-2300
Mailing Address - Fax:410-692-9266
Practice Address - Street 1:3300 ELY RD
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-1120
Practice Address - Country:US
Practice Address - Phone:410-692-2300
Practice Address - Fax:410-692-9266
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02126111N00000X
PADC008814111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD987RMedicare PIN