Dematteo Pugh, Theresa L

Dematteo Pugh, Theresa L is an individual health care provider with primary practice located at 4924 Campbell Blvd Suite 200, Nottingham MD 21236-5908. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Pediatrics, which is considered as her primary health care specialty. Dematteo Pugh, Theresa L can be contacted via phone (443) 442-2300.

Contact Information

Primary practice address
4924 Campbell Blvd Suite 200 Nottingham MD 21236-5908
Phone: (443) 442-2300
Fax: (443) 442-2360
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Pediatrics 363LP0200X R076644 Maryland

Profile Details

NPI number 1841390713
LBN Legal business name Dematteo Pugh, Theresa L
Credentials MS CRNP
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 22nd, 2006
Last updated May 9th, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841390713 NPPES
Maryland MEDICAID 622361300

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