Provider Demographics
NPI:1891201216
Name:MASTERPIECE INSTITUTE OF AESTHETICS AND GYNECOLOGY
Entity Type:Organization
Organization Name:MASTERPIECE INSTITUTE OF AESTHETICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHADIJA
Authorized Official - Middle Name:N
Authorized Official - Last Name:DUGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:443-569-0411
Mailing Address - Street 1:45 ASPEN WOODS DR
Mailing Address - Street 2:
Mailing Address - City:SUNDERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20689-3013
Mailing Address - Country:US
Mailing Address - Phone:443-569-0411
Mailing Address - Fax:443-703-3201
Practice Address - Street 1:116 DEFENSE HWY STE 501
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:215-432-8534
Practice Address - Fax:443-703-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0074779207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty