Provider Demographics
NPI:1689675258
Name:PUGACH, NEIL (MD)
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:PUGACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 MEDICAL PKWY
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4985
Mailing Address - Country:US
Mailing Address - Phone:757-547-0508
Mailing Address - Fax:757-547-8963
Practice Address - Street 1:300 MEDICAL PKWY
Practice Address - Street 2:SUITE 212
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4985
Practice Address - Country:US
Practice Address - Phone:757-547-0508
Practice Address - Fax:757-547-8963
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052787174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7600631Medicaid
E02658Medicare UPIN
130000707Medicare ID - Type UnspecifiedMEDICARE PROVIDER NO.