Provider Demographics
NPI:1366478224
Name:ENGLERT, DEBORAH ANN (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:ENGLERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FILA WAY STE 205
Mailing Address - Street 2:
Mailing Address - City:SPARKS GLENCOE
Mailing Address - State:MD
Mailing Address - Zip Code:21152-9454
Mailing Address - Country:US
Mailing Address - Phone:410-472-1006
Mailing Address - Fax:410-472-0900
Practice Address - Street 1:10 FILA WAY STE 205
Practice Address - Street 2:
Practice Address - City:SPARKS GLENCOE
Practice Address - State:MD
Practice Address - Zip Code:21152-9454
Practice Address - Country:US
Practice Address - Phone:410-472-1006
Practice Address - Fax:410-472-0900
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD63690207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS045-0028OtherBLUE SHIELD FEDERAL
MD64787001OtherCAREFIRST OF MD
MDH37938Medicare UPIN
MDN085Medicare PIN