Provider Demographics
NPI:1619051679
Name:JOHN SKOUGE , M.D.,P.A.
Entity Type:Organization
Organization Name:JOHN SKOUGE , M.D.,P.A.
Other - Org Name:JOHN SKOUGE, M.D.,P.A.
Other - Org Type:Other Name
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:SKOUGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-825-6810
Mailing Address - Street 1:1302 BELLONA AVE
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5425
Mailing Address - Country:US
Mailing Address - Phone:410-825-6810
Mailing Address - Fax:410-825-1621
Practice Address - Street 1:1302 BELLONA AVE
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5425
Practice Address - Country:US
Practice Address - Phone:410-825-6810
Practice Address - Fax:410-825-1621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1237261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD7665OtherBLUE CROSS/BLUE SHIELD
MD7665OtherBLUE CROSS/BLUE SHIELD
MDB67191Medicare UPIN