Provider Demographics
NPI:1780837534
Name:BRUGER, PETER JOSEPH (PA C)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:BRUGER
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5430 CAMPBELL BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WHITE MARSH
Mailing Address - State:MD
Mailing Address - Zip Code:21162-5500
Mailing Address - Country:US
Mailing Address - Phone:443-725-4930
Mailing Address - Fax:443-725-4933
Practice Address - Street 1:5430 CAMPBELL BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:WHITE MARSH
Practice Address - State:MD
Practice Address - Zip Code:21162-5500
Practice Address - Country:US
Practice Address - Phone:443-725-4930
Practice Address - Fax:443-725-4933
Is Sole Proprietor?:No
Enumeration Date:2008-10-24
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC03868363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical