Provider Demographics
NPI:1558612416
Name:PANGILINAN, ALAIN
Entity Type:Individual
Prefix:MR
First Name:ALAIN
Middle Name:
Last Name:PANGILINAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 PRIMROSE CT APT 201
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21403-5150
Mailing Address - Country:US
Mailing Address - Phone:856-375-5938
Mailing Address - Fax:
Practice Address - Street 1:1109 PRIMROSE CT APT 201
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21403-5150
Practice Address - Country:US
Practice Address - Phone:856-375-5938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23869225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist