Provider Demographics
NPI:1861486060
Name:MUGMON, MARC A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:A
Last Name:MUGMON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-602-9262
Mailing Address - Fax:410-602-9276
Practice Address - Street 1:3333 N CALVERT ST
Practice Address - Street 2:STE 500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-2867
Practice Address - Country:US
Practice Address - Phone:410-366-5600
Practice Address - Fax:410-889-4952
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2010-08-30
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Provider Licenses
StateLicense IDTaxonomies
MDD0017225207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD968391700Medicaid
B67122Medicare UPIN
MD968391700Medicaid