Provider Demographics
NPI:1508989989
Name:CUGALJ, ADAM PAVLE (DO)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:PAVLE
Last Name:CUGALJ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:4 HAWTHORNE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6983
Mailing Address - Country:US
Mailing Address - Phone:603-472-8888
Mailing Address - Fax:603-472-9090
Practice Address - Street 1:4 HAWTHORNE DR
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6983
Practice Address - Country:US
Practice Address - Phone:603-472-8888
Practice Address - Fax:603-472-9090
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14010208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30226724Medicaid
9065161OtherAETNA
NY02899627Medicaid
AA121468OtherHARVARD PILGRIM
VT1015184Medicaid
613430500OtherUS DEPARTMENT OF LABOR
3004741OtherMVP HEALTHCARE
3004741OtherMVP HEALTHCARE
NY5309Medicare PIN