Provider Demographics
NPI:1598069650
Name:DENNIS KURGANSKY, MD, PA
Entity Type:Organization
Organization Name:DENNIS KURGANSKY, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KURGANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-893-2313
Mailing Address - Street 1:2 NORTH AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2303
Mailing Address - Country:US
Mailing Address - Phone:410-893-2313
Mailing Address - Fax:410-893-7742
Practice Address - Street 1:2 NORTH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2303
Practice Address - Country:US
Practice Address - Phone:410-893-2313
Practice Address - Fax:410-893-7742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-04
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD36007261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE42055Medicare UPIN