Provider Demographics
NPI:1932232246
Name:LAUGHLIN, JACQUIE (PA)
Entity Type:Individual
Prefix:
First Name:JACQUIE
Middle Name:
Last Name:LAUGHLIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2827 GRAYBILL CT
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:MD
Mailing Address - Zip Code:21776-9714
Mailing Address - Country:US
Mailing Address - Phone:410-875-5866
Mailing Address - Fax:
Practice Address - Street 1:5930 FREDERICK CROSSING LN
Practice Address - Street 2:ADVANCED URGENT CARE F FREDERICK
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-5137
Practice Address - Country:US
Practice Address - Phone:240-379-7776
Practice Address - Fax:240-379-7787
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001722363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD53760Medicare UPIN