Provider Demographics
NPI:1598778623
Name:USCG
Entity Type:Organization
Organization Name:USCG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:FULTCHER
Authorized Official - Suffix:
Authorized Official - Credentials:CWO
Authorized Official - Phone:410-636-7506
Mailing Address - Street 1:2401 HAWKINS POINT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21226-1797
Mailing Address - Country:US
Mailing Address - Phone:410-636-7506
Mailing Address - Fax:
Practice Address - Street 1:2401 HAWKINS POINT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21226-1797
Practice Address - Country:US
Practice Address - Phone:410-636-7506
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure