Provider Demographics
NPI:1558694885
Name:DR DOUGLAS WRIGHT
Entity Type:Organization
Organization Name:DR DOUGLAS WRIGHT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-569-3690
Mailing Address - Street 1:2012 S TOLLGATE RD
Mailing Address - Street 2:STE 109
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5901
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2012 S TOLLGATE RD
Practice Address - Street 2:STE 109
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5901
Practice Address - Country:US
Practice Address - Phone:410-569-3690
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-18
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD207X00000XOtherPROVIDER TAXONOMY
MD207X00000XOtherPROVIDER TAXONOMY
E15027Medicare UPIN