Provider Demographics
NPI:1881632354
Name:TAGLE, ARNEL M (MD)
Entity Type:Individual
Prefix:DR
First Name:ARNEL
Middle Name:M
Last Name:TAGLE
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:PO BOX 62026
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-2026
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:301 SAINT PAUL PL
Practice Address - Street 2:PHYS OFFICE BLDG., SUITE 907
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202-2102
Practice Address - Country:US
Practice Address - Phone:410-659-0808
Practice Address - Fax:410-547-8523
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053517207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDS190/ 0032OtherBLUE CHOICE
MD112002600Medicaid
MDKF68/ 645105-03OtherBC/BS OF MD
MD112002600Medicaid
MDS190/ 0032OtherBLUE CHOICE