Provider Demographics
NPI:1801083845
Name:ROBERT F HOOFNAGLE JR MD PA
Entity type:Organization
Organization Name:ROBERT F HOOFNAGLE JR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NAGLIERI
Authorized Official - Suffix:
Authorized Official - Credentials:CMIS
Authorized Official - Phone:443-643-9900
Mailing Address - Street 1:2 NORTH AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-2303
Mailing Address - Country:US
Mailing Address - Phone:443-643-9900
Mailing Address - Fax:443-643-9999
Practice Address - Street 1:2 NORTH AVE STE 102
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-2303
Practice Address - Country:US
Practice Address - Phone:443-643-9900
Practice Address - Fax:443-643-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDBH1418739208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD143PMedicare PIN