Provider Demographics
NPI:1831163575
Name:PUGH, ERNEST O (MD)
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:O
Last Name:PUGH
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 79777
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-0777
Mailing Address - Country:US
Mailing Address - Phone:434-654-7794
Mailing Address - Fax:434-977-9808
Practice Address - Street 1:315 10TH ST NE
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22902-5316
Practice Address - Country:US
Practice Address - Phone:434-654-1950
Practice Address - Fax:434-977-9808
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101046325207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W402A35Medicare PIN
E55723Medicare UPIN
VAP00233758Medicare PIN